Provider Demographics
NPI:1124202031
Name:UNIVERSAL MEDICAL & REHABILITATION CENTER, S.C.
Entity type:Organization
Organization Name:UNIVERSAL MEDICAL & REHABILITATION CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FATIMA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOHIUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1847-390-7122
Mailing Address - Street 1:9120 W GOLF RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-5806
Mailing Address - Country:US
Mailing Address - Phone:847-390-7122
Mailing Address - Fax:847-390-7115
Practice Address - Street 1:2828 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1502
Practice Address - Country:US
Practice Address - Phone:773-761-9774
Practice Address - Fax:773-761-9878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036079439Medicaid
IL036092848Medicaid
IL0404246OtherUNITEDHEALTHCARE
IL21621391OtherBLUE CROSS/BLUE SHIELD
IL335989271001Medicaid
IL4140282OtherAETNA
IL250733OtherHARMONY
IL1156492OtherFIRST HEALTH
IL030004494OtherRAILROAD MEDICARE
IL328026621001Medicaid
IL110239089OtherRAILROAD MEDICARE
ILK13816Medicare PIN
IL250733OtherHARMONY
IL328026621001Medicaid
IL21621391OtherBLUE CROSS/BLUE SHIELD