Provider Demographics
NPI:1518174705
Name:CHICAGO PT MANAGEMENT, INC.
Entity Type:Organization
Organization Name:CHICAGO PT MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:P
Authorized Official - Last Name:OWEIMRIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:773-490-0151
Mailing Address - Street 1:800 E NORTHWEST HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3457
Mailing Address - Country:US
Mailing Address - Phone:847-227-8400
Mailing Address - Fax:847-239-7686
Practice Address - Street 1:8019 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3611
Practice Address - Country:US
Practice Address - Phone:773-490-0151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010227208100000X
261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216447OtherMEDICARE PTAN
ILK50748Medicare PIN