MEDICARE: MEA-SJMC, LLC

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	207P00000X	Emergency Medicine Physician	036075657	IL

General Provider Information

NPI Number	:	1659325041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEA-SJMC, LLC

Provider Business Mailing Address
First Line	:	2000 SPRING RD
Second Line	:	STE 200
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1804
Country	:	US
Telephone Number	:	630-472-8810
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 SPRING RD
Second Line	:	STE 200
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1804
Country	:	US
Telephone Number	:	630-472-8810
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SAIF NAZIR
Credential	:	M.D.
Telephone Number	:	630-472-8810

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	01/24/2012

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