| Mirshed Medical Center S C | |
|
4255 W 63rd St Chicago IL 60629-5041 | |
| (773) 424-4048 | |
| (773) 424-6463 |
| Full Name | Mirshed Medical Center S C |
|---|---|
| Speciality | Internal Medicine |
| Location | 4255 W 63rd St, Chicago, Illinois |
| Authorized Official Name and Position | Nayeh Edwin Mirshed (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7734244048 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mirshed Medical Center S C 4255 W 63rd St Chicago IL 60629-5041 Ph: (773) 424-4048 | Mirshed Medical Center S C 4255 W 63rd St Chicago IL 60629-5041 Ph: (773) 424-4048 |
| NPI Number | 1083880637 |
|---|---|
| Provider Enumeration Date | 05/05/2008 |
| Last Update Date | 11/05/2008 |
| Medicare PECOS PAC ID | 8729153432 |
|---|---|
| Medicare Enrollment ID | O20080814000530 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083880637 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036-091913 (Illinois) | Primary |
| Provider Name | Nayeh E Mirshed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689662892 PECOS PAC ID: 0345321881 Enrollment ID: I20080122000748 |
| Provider Name | Luvianca J Fonseca |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205824406 PECOS PAC ID: 4082789797 Enrollment ID: I20080814000554 |
| Provider Name | Margie Ortiz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871058842 PECOS PAC ID: 5991047185 Enrollment ID: I20190509001109 |
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