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General NPI Number Information
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NPI Number | 1760721955
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Entity Type | Organization
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Legal Business Name | SINAI MEDICAL GROUP DIABETES EDUCATION PROGRAM 003816
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Dates
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Enumeration Date | 02/07/2013
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Last Update Date | 09/28/2020
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Provider Practice Location Address
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Address Line | 2653 W OGDEN AVE STE 3
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City | CHICAGO
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State | IL
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Zip | 60608-1647
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Country | US
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Telephone | 773-257-6701
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Fax |
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Provider Business Mailing Address
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Address Line | 26460 NETWORK PLACE
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City | CHICAGO
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State | IL
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Zip | 60674-0001
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Country | US
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Telephone | 773-257-2820
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Fax | 773-762-8529
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Authorized Official
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Title or Position | PRESIDENT SINAI MEDIAL GROUP
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Name | EDWARD CARNE
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Credential |
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Telephone | 773-257-5771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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