Provider Demographics
NPI:1922338623
Name:DEAN MEDICAL, SC
Entity Type:Organization
Organization Name:DEAN MEDICAL, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FAUZIA
Authorized Official - Middle Name:WAJID
Authorized Official - Last Name:LODHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-673-2990
Mailing Address - Street 1:6501 N. SAUGANASH
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712
Mailing Address - Country:US
Mailing Address - Phone:847-673-2990
Mailing Address - Fax:
Practice Address - Street 1:6501 N. SAUGANASH
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712
Practice Address - Country:US
Practice Address - Phone:847-673-2990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.085761207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF56106Medicare UPIN