Provider Demographics
NPI:1740474584
Name:FORYS BIRN AND ASSOC P C
Entity type:Organization
Organization Name:FORYS BIRN AND ASSOC P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:ALEKSANDER
Authorized Official - Last Name:FORYS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-545-2525
Mailing Address - Street 1:5605 W GUNNISON STR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3212
Mailing Address - Country:US
Mailing Address - Phone:773-545-2525
Mailing Address - Fax:773-205-5700
Practice Address - Street 1:5605 W GUNNISON STR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3212
Practice Address - Country:US
Practice Address - Phone:773-545-2525
Practice Address - Fax:773-205-5700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL539450Medicare PIN