Provider Demographics
NPI:1356406961
Name:MAIN MEDICAL CENTER LTD
Entity type:Organization
Organization Name:MAIN MEDICAL CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HISHAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:SADEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-629-9108
Mailing Address - Street 1:683 KATHERINE LN
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101
Mailing Address - Country:US
Mailing Address - Phone:630-629-9108
Mailing Address - Fax:708-444-1124
Practice Address - Street 1:683 KATHERINE LN
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101
Practice Address - Country:US
Practice Address - Phone:630-629-9108
Practice Address - Fax:708-444-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232560OtherBCBS
IL209990Medicare ID - Type Unspecified
IL02232560OtherBCBS