Provider Demographics
NPI:1972143725
Name:EIKRS SERVICE CORPORATION
Entity Type:Organization
Organization Name:EIKRS SERVICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EJAZ
Authorized Official - Middle Name:N
Authorized Official - Last Name:JAFRI
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:630-251-0206
Mailing Address - Street 1:5 WHEATON CTR APT 225
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4991
Mailing Address - Country:US
Mailing Address - Phone:630-251-0206
Mailing Address - Fax:
Practice Address - Street 1:5 WHEATON CTR APT 225
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4991
Practice Address - Country:US
Practice Address - Phone:630-251-0206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-09
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041414951Medicaid