Provider Demographics
NPI:1275570806
Name:MEA-SJ CARE CENTERS, LLC
Entity Type:Organization
Organization Name:MEA-SJ CARE CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAIF
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-472-8810
Mailing Address - Street 1:2000 SPRING RD
Mailing Address - Street 2:STE 200
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1804
Mailing Address - Country:US
Mailing Address - Phone:630-482-8810
Mailing Address - Fax:
Practice Address - Street 1:PROVENA ST JOSEPH MED CARE CTR
Practice Address - Street 2:2250 W ALGONQUIN RD
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156
Practice Address - Country:US
Practice Address - Phone:847-845-5511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036075657207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty