Provider Demographics
NPI:1063653905
Name:MIDWEST PULMONARY & SLEEP CLINIC
Entity Type:Organization
Organization Name:MIDWEST PULMONARY & SLEEP CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIDAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-240-9500
Mailing Address - Street 1:802 E WOODFIELD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4712
Mailing Address - Country:US
Mailing Address - Phone:847-240-9500
Mailing Address - Fax:847-240-9501
Practice Address - Street 1:1442 MERCHANT DR
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5917
Practice Address - Country:US
Practice Address - Phone:847-658-0909
Practice Address - Fax:847-658-6709
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST PULMONARY & SLEEP CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108121207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108121Medicaid
IL212072OtherMEDICARE ID-TYPE UNSPECIFIED
IL1635330OtherBLUE CROSS BLUE SHIELD