Provider Demographics
NPI:1033348206
Name:FAYCOR N A INC
Entity Type:Organization
Organization Name:FAYCOR N A INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:FEINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-291-9058
Mailing Address - Street 1:2535 GREENVIEW RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-7031
Mailing Address - Country:US
Mailing Address - Phone:847-291-9058
Mailing Address - Fax:847-291-9095
Practice Address - Street 1:4700 N MARINE DR
Practice Address - Street 2:5TH FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5120
Practice Address - Country:US
Practice Address - Phone:847-291-9058
Practice Address - Fax:847-291-9095
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR.CHARLES FEINSTEIN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-09
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064248261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064248Medicaid
IL036064248Medicaid