Provider Demographics
NPI:1366497026
Name:CHICAGO NASAL AND SINUS CENTER S C
Entity Type:Organization
Organization Name:CHICAGO NASAL AND SINUS CENTER S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PRITIKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-372-9355
Mailing Address - Street 1:111 W WASHINGTON ST STE 903
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-2762
Mailing Address - Country:US
Mailing Address - Phone:312-372-9355
Mailing Address - Fax:312-372-9356
Practice Address - Street 1:111 W WASHINGTON ST
Practice Address - Street 2:SUITE 903
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2703
Practice Address - Country:US
Practice Address - Phone:312-372-9355
Practice Address - Fax:312-372-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-087346207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL040017908OtherRRMC
IL0001633140OtherBLUE SHIELD
IL040017908OtherRRMC
IL0001633140OtherBLUE SHIELD
IL205006Medicare PIN