MEDICARE: UNIVERSAL MEDICAL & REHABILITATION 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	208100000X	Physical Medicine & Rehabilitation Physician
2	207R00000X	Internal Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	030004494	OTHER	IL	RAILROAD MEDICARE
11	110239089	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0404246	OTHER	IL	UNITEDHEALTHCARE
4	21621391	OTHER	IL	BLUE CROSS/BLUE SHIELD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	4140282	OTHER	IL	AETNA
7	250733	OTHER	IL	HARMONY
8	1156492	OTHER	IL	FIRST HEALTH
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124202031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSAL MEDICAL & REHABILITATION CENTER, S.C.

Provider Business Mailing Address
First Line	:	9120 W GOLF RD
Second Line	:
City	:	NILES
State	:	IL
Zip	:	60714-5806
Country	:	US
Telephone Number	:	847-390-7122
Fax Number	:	847-390-7115

Provider Business Practice Location Address
First Line	:	2828 W DEVON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-1502
Country	:	US
Telephone Number	:	773-761-9774
Fax Number	:	773-761-9878

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FATIMA M MOHIUDDIN
Credential	:	M.D.
Telephone Number	:	18473907122

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	12/27/2007

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