MEDICARE: SUNRISE MEDICAL 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	261Q00000X	Clinic/Center		IL

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

General Provider Information

NPI Number	:	1821079955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNRISE MEDICAL CENTER S. C.

Provider Business Mailing Address
First Line	:	16750 80TH AVE
Second Line	:	STE D
City	:	TINLEY PARK
State	:	IL
Zip	:	60477-3173
Country	:	US
Telephone Number	:	708-633-8300
Fax Number	:	708-633-8091

Provider Business Practice Location Address
First Line	:	16750 80TH AVE
Second Line	:	STE D
City	:	TINLEY PARK
State	:	IL
Zip	:	60477-3173
Country	:	US
Telephone Number	:	708-633-8300
Fax Number	:	708-633-8091

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CECILIA IBRAHIM
Credential	:	M.D.
Telephone Number	:	708-633-8300

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	08/22/2020

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