=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801228648
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OZGUL UZGUN INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2013
-----------------------------------------------------
Last Update Date | 08/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7634 W BALMORAL AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60656-1724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-804-4268
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7634 W BALMORAL AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60656-1724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | OZGUL UZGUN
-----------------------------------------------------
Credential | M ED
-----------------------------------------------------
Telephone | 631-804-4268
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------