Provider Demographics
NPI:1598804726
Name:OCCUPATIONAL MEDICAL CENTER OF CHICAGO SC
Entity Type:Organization
Organization Name:OCCUPATIONAL MEDICAL CENTER OF CHICAGO SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-239-1400
Mailing Address - Street 1:1751 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643
Mailing Address - Country:US
Mailing Address - Phone:773-239-1400
Mailing Address - Fax:773-239-0400
Practice Address - Street 1:1751 W 95TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643
Practice Address - Country:US
Practice Address - Phone:773-239-1400
Practice Address - Fax:773-239-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208100000X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Not Answered2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty