Provider Demographics
NPI:1033396239
Name:MEDICAL SPECIALIST
Entity Type:Organization
Organization Name:MEDICAL SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BIRINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARWAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-592-7235
Mailing Address - Street 1:30 HAMILTON LN
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1753
Mailing Address - Country:US
Mailing Address - Phone:773-592-7235
Mailing Address - Fax:
Practice Address - Street 1:400 E 41ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-3071
Practice Address - Country:US
Practice Address - Phone:773-592-7235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL348240Medicare PIN