MEDICARE: SMCCS, INC.

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	207RS0012X	Sleep Medicine (Internal Medicine) Physician
2	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician

General Provider Information

NPI Number	:	1336593714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMCCS, INC.

Provider Business Mailing Address
First Line	:	490 W LAKE ST UNIT 3
Second Line	:
City	:	ROSELLE
State	:	IL
Zip	:	60172-3551
Country	:	US
Telephone Number	:	630-550-7252
Fax Number	:

Provider Business Practice Location Address
First Line	:	490 W LAKE ST UNIT 3
Second Line	:
City	:	ROSELLE
State	:	IL
Zip	:	60172-3551
Country	:	US
Telephone Number	:	630-550-7252
Fax Number	:	866-656-1698

Authorized Official
Title or Position	:	CEO
Name	:	NOOR FATIMA HUSAIN
Credential	:	M.D.
Telephone Number	:	630-550-7252

Provider Enumeration Date	:	04/21/2016
Last Update Date	:	10/24/2022

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Directions to “SMCCS, INC. ” Practice Location

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