Provider Demographics
NPI:1093453086
Name:SELECT MED NETWORK
Entity Type:Organization
Organization Name:SELECT MED NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIAKULAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-687-9535
Mailing Address - Street 1:9 S ELMHURST RD UNIT 350
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60070-7912
Mailing Address - Country:US
Mailing Address - Phone:847-687-9535
Mailing Address - Fax:
Practice Address - Street 1:901 N QUINCE LN
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-1501
Practice Address - Country:US
Practice Address - Phone:847-687-9535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-20
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health