Provider Demographics
NPI:1316037120
Name:A & D MEDICAL CENTER SC
Entity Type:Organization
Organization Name:A & D MEDICAL CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAWED
Authorized Official - Middle Name:
Authorized Official - Last Name:EHSAN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:847-742-0165
Mailing Address - Street 1:64 N ALFRED AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5284
Mailing Address - Country:US
Mailing Address - Phone:847-742-0165
Mailing Address - Fax:847-742-0190
Practice Address - Street 1:64 N ALFRED AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5284
Practice Address - Country:US
Practice Address - Phone:847-742-0165
Practice Address - Fax:847-742-0190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00090413OtherRAILROAD
209598OtherMEDICARE ID
IL04532181OtherBCBS
K33103Medicare PIN
P00090413OtherRAILROAD
214416Medicare PIN