MEDICARE: OCCUPATIONAL HEALTH CENTERS OF ILLINOIS PC

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	261QX0100X	Occupational Medicine Clinic/Center

General Provider Information

NPI Number	:	1437298775
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCCUPATIONAL HEALTH CENTERS OF ILLINOIS PC

Provider Business Mailing Address
First Line	:	5080 SPECTRUM DR
Second Line	:	SUITE 1200 WEST
City	:	ADDISON
State	:	TX
Zip	:	75001-4648
Country	:	US
Telephone Number	:	972-364-8000
Fax Number	:	214-775-4502

Provider Business Practice Location Address
First Line	:	2080 SPRINGER DR
Second Line	:
City	:	LOMBARD
State	:	IL
Zip	:	60148-6402
Country	:	US
Telephone Number	:	630-932-4540
Fax Number	:	630-932-4745

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAAD A YALDO
Credential	:
Telephone Number	:	972-364-8000

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	09/13/2018

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