MEDICARE: CENTER FOR FUNCTIONAL REHABILITATION

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	261QM1300X	Multi-Specialty Clinic/Center	036-117058	IL
2	261QP3300X	Pain Clinic/Center	036-117058	IL

General Provider Information

NPI Number	:	1457724114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR FUNCTIONAL REHABILITATION

Provider Business Mailing Address
First Line	:	820 W JACKSON BLVD
Second Line	:	SUITE 310
City	:	CHICAGO
State	:	IL
Zip	:	60607-3026
Country	:	US
Telephone Number	:	312-757-4647
Fax Number	:	312-724-7647

Provider Business Practice Location Address
First Line	:	820 W JACKSON BLVD
Second Line	:	SUITE 310
City	:	CHICAGO
State	:	IL
Zip	:	60607-3026
Country	:	US
Telephone Number	:	312-757-4647
Fax Number	:	312-724-7647

Authorized Official
Title or Position	:	OWNER
Name	:	SAJJAD MURTAZA
Credential	:	M.D.
Telephone Number	:	312-757-4647

Provider Enumeration Date	:	11/03/2015
Last Update Date	:	11/03/2015

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Directions to “CENTER FOR FUNCTIONAL REHABILITATION ” Practice Location

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