| Burbank Medical Group Inc | |
|
4817 W 83rd St Burbank IL 60429 | |
| (708) 425-3135 | |
| (708) 425-6884 |
| Full Name | Burbank Medical Group Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4817 W 83rd St, Burbank, Illinois |
| Authorized Official Name and Position | Jalal Dahshe (PROVIDER) |
| Authorized Official Contact | 7084253135 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Burbank Medical Group Inc 9229 Massasoit Ave Oak Lawn IL 60453 Ph: (708) 422-2023 | Burbank Medical Group Inc 4817 W 83rd St Burbank IL 60429 Ph: (708) 425-3135 |
| NPI Number | 1508107061 |
|---|---|
| Provider Enumeration Date | 03/08/2013 |
| Last Update Date | 03/08/2013 |
| Medicare PECOS PAC ID | 3375784242 |
|---|---|
| Medicare Enrollment ID | O20130719000281 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508107061 | NPI | - | NPPES |
| 030088926 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036088926 (Illinois) | Primary |
| Provider Name | Jalal Dahshe |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790716967 PECOS PAC ID: 6204734650 Enrollment ID: I20031223000335 |
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