MEDICARE: MIRSHED MEDICAL CENTER S C

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036-091913	IL

General Provider Information

NPI Number	:	1083880637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRSHED MEDICAL CENTER S C

Provider Business Mailing Address
First Line	:	4255 W 63RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-5041
Country	:	US
Telephone Number	:	773-424-4048
Fax Number	:	773-424-6463

Provider Business Practice Location Address
First Line	:	4255 W 63RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-5041
Country	:	US
Telephone Number	:	773-424-4048
Fax Number	:	773-424-6463

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. NAYEH EDWIN MIRSHED
Credential	:	M.D.
Telephone Number	:	773-424-4048

Provider Enumeration Date	:	05/05/2008
Last Update Date	:	11/05/2008

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Directions to “MIRSHED MEDICAL CENTER S C ” Practice Location

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