Basic Information
| Provider Information | |||||||||
| NPI: | 1922449248 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OCCUPATIONAL HEALTH CENTERS OF ILLINOIS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5080 SPECTRUM DR | ||||||||
| Address2: | SUITE 1200 WEST | ||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750014648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723648000 | ||||||||
| FaxNumber: | 2147754502 | ||||||||
| Practice Location | |||||||||
| Address1: | 7421 S CASS AVE | ||||||||
| Address2: | |||||||||
| City: | DARIEN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605613607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302865300 | ||||||||
| FaxNumber: | 6309861096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2013 | ||||||||
| LastUpdateDate: | 06/29/2016 | ||||||||
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| AuthorizedOfficialLastName: | YALDO | ||||||||
| AuthorizedOfficialFirstName: | RAAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT AND TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 9723648000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QX0100X | N | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.