Provider Demographics
NPI:1700227279
Name:UNIFIED PHYSICIANS NETWORK ACO, LLC
Entity Type:Organization
Organization Name:UNIFIED PHYSICIANS NETWORK ACO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAFAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH-MIRANY
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:847-763-1700
Mailing Address - Street 1:5215 OLD ORCHARD RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1035
Mailing Address - Country:US
Mailing Address - Phone:847-763-1700
Mailing Address - Fax:847-676-6983
Practice Address - Street 1:5215 OLD ORCHARD RD
Practice Address - Street 2:SUITE 340
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1035
Practice Address - Country:US
Practice Address - Phone:847-763-1700
Practice Address - Fax:847-676-6983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization