Provider Demographics
NPI:1548533870
Name:SKOKIE MEDICAL CENTER LLC
Entity type:Organization
Organization Name:SKOKIE MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MEHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSIRATPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-605-2646
Mailing Address - Street 1:3S138 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-7233
Mailing Address - Country:US
Mailing Address - Phone:630-605-2646
Mailing Address - Fax:630-790-0655
Practice Address - Street 1:8301 SKOKIE BLVD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2546
Practice Address - Country:US
Practice Address - Phone:847-674-4481
Practice Address - Fax:847-674-4491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036106820261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care