Provider Demographics
NPI:1083667794
Name:VISHAR MEDICAL CENTER SC
Entity Type:Organization
Organization Name:VISHAR MEDICAL CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-721-0322
Mailing Address - Street 1:PO BOX 10428
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46411-0428
Mailing Address - Country:US
Mailing Address - Phone:219-681-2065
Mailing Address - Fax:219-681-2066
Practice Address - Street 1:2315 E 93RD ST
Practice Address - Street 2:SUITE 340
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3910
Practice Address - Country:US
Practice Address - Phone:773-721-0322
Practice Address - Fax:773-721-1471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCL8627OtherRAILROAD MEDICARE
IL213817Medicare PIN