Provider Demographics
NPI:1689627168
Name:DIABETES & ENDOCRINE CARE LTD
Entity Type:Organization
Organization Name:DIABETES & ENDOCRINE CARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMMAR
Authorized Official - Middle Name:ADNAN
Authorized Official - Last Name:BAYRAKDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-422-0022
Mailing Address - Street 1:2955 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2409
Mailing Address - Country:US
Mailing Address - Phone:708-422-0022
Mailing Address - Fax:708-422-2266
Practice Address - Street 1:2955 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2409
Practice Address - Country:US
Practice Address - Phone:708-422-0022
Practice Address - Fax:708-422-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086922207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212676Medicare PIN