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General NPI Number Information
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NPI Number | 1700058898
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Entity Type | Organization
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Legal Business Name | BURBANK MEDICAL CENTER SC
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Dates
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Enumeration Date | 03/28/2008
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 4817 W 83RD ST
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City | BURBANK
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State | IL
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Zip | 60459-2790
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Country | US
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Telephone | 708-425-3135
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Fax | 708-425-6884
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Provider Business Mailing Address
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Address Line | 4817 W 83RD ST
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City | BURBANK
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State | IL
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Zip | 60459-2790
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Country | US
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Telephone | 708-425-3135
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Fax | 708-425-6884
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Authorized Official
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Title or Position | PRESIDENT
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Name | JALAL DAHSHE
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Credential | MD
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Telephone | 708-425-3135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 036054337
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016002638
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036088926
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License Number State | IL
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