| Carend Provider Group Pa | |
|
3752 N Sheffield Ave Apt 3s Chicago IL 60613-0305 | |
| (708) 630-1534 | |
| Not Available |
| Full Name | Carend Provider Group Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3752 N Sheffield Ave Apt 3s, Chicago, Illinois |
| Authorized Official Name and Position | Awss Zidan (PRESIDENT) |
| Authorized Official Contact | 7086301534 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carend Provider Group Pa 2045 W Grand Ave Ste B #47606 Chicago IL 60612-1577 Ph: (708) 630-1534 | Carend Provider Group Pa 3752 N Sheffield Ave Apt 3s Chicago IL 60613-0305 Ph: (708) 630-1534 |
| NPI Number | 1962161315 |
|---|---|
| Provider Enumeration Date | 12/14/2021 |
| Last Update Date | 04/08/2024 |
| Certification Date | 04/08/2024 |
| Medicare PECOS PAC ID | 2264827518 |
|---|---|
| Medicare Enrollment ID | O20220610000352 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962161315 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Eric Anderson |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1588808034 PECOS PAC ID: 1557504826 Enrollment ID: I20201013002230 |
| Provider Name | Jaime Hatcher Martin |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1649406380 PECOS PAC ID: 6507006806 Enrollment ID: I20220706003435 |
| Provider Name | Theodore Tom Faber |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1558372995 PECOS PAC ID: 8123117249 Enrollment ID: I20221117001831 |
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