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General NPI Number Information
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NPI Number | 1912447442
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Entity Type | Organization
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Legal Business Name | 63RD MEDICAL & SURGICAL CENTER, LLC
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Dates
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Enumeration Date | 03/02/2017
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Last Update Date | 03/08/2017
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Provider Practice Location Address
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Address Line | 3918 W 63RD ST
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City | CHICAGO
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State | IL
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Zip | 60629-4604
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Country | US
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Telephone | 773-284-9660
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Fax | 773-284-9676
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Provider Business Mailing Address
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Address Line | PO BOX 11232
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City | CHICAGO
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State | IL
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Zip | 60611-0232
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Country | US
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Telephone | 773-284-9660
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Fax | 773-284-9676
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. AYOUB SAYEG
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Credential | M.D.
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Telephone | 773-284-9660
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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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