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General NPI Number Information
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NPI Number | 1194946343
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Entity Type | Organization
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Legal Business Name | CRESCENT MEDICAL CENTER INC
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1008 W FOSTER AVE
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City | CHICAGO
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State | IL
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Zip | 60640
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Country | US
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Telephone | 773-561-5000
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Fax | 773-561-2503
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Provider Business Mailing Address
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Address Line | 606 W MEADOW AVE
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City | LOMBARD
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State | IL
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Zip | 60148
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Country | US
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Telephone | 630-627-9505
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANEES FATIMA
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Credential | M D
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Telephone | 630-697-3672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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