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General NPI Number Information
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NPI Number | 1992927511
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Entity Type | Organization
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Legal Business Name | PEARL MEDICAL CENTER S.C.
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 11/19/2007
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Provider Practice Location Address
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Address Line | 1945 W WILSON AVE STE 5115
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City | CHICAGO
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State | IL
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Zip | 60640-5258
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Country | US
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Telephone | 773-506-1234
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Fax | 773-506-1235
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Provider Business Mailing Address
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Address Line | 4926 N CHRISTIANA AVE
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City | CHICAGO
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State | IL
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Zip | 60625-5004
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Country | US
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Telephone | 773-866-2182
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Fax | 773-866-1182
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MUQSITA NASHAT
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Credential | M.D.
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Telephone | 773-506-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | IL
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