MEDICARE: DEEN HEALTH SYSTEM LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	111N00000X	Chiropractor
2	207V00000X	Obstetrics & Gynecology Physician
3	207X00000X	Orthopaedic Surgery Physician
4	208VP0014X	Interventional Pain Medicine Physician
5	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1043718190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEEN HEALTH SYSTEM LLC

Provider Business Mailing Address
First Line	:	4909 W DIVISION ST STE 101
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60651-3108
Country	:	US
Telephone Number	:	773-552-1355
Fax Number	:

Provider Business Practice Location Address
First Line	:	2611 S LAWNDALE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-4520
Country	:	US
Telephone Number	:	773-521-6666
Fax Number	:	833-404-2600

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. MOHAMED S SIRAJUDEEN
Credential	:
Telephone Number	:	773-552-1355

Provider Enumeration Date	:	01/23/2018
Last Update Date	:	06/16/2018

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Directions to “DEEN HEALTH SYSTEM LLC ” Practice Location

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