Provider Demographics
NPI:1780908434
Name:CHICAGO ELECTRICAL TRAUMA RESEARCH INSTITUTE
Entity type:Organization
Organization Name:CHICAGO ELECTRICAL TRAUMA RESEARCH INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FARNAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDOLLAHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-904-0347
Mailing Address - Street 1:4047 W. 40TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632
Mailing Address - Country:US
Mailing Address - Phone:800-516-8709
Mailing Address - Fax:888-221-3183
Practice Address - Street 1:4047 W. 40TH STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632
Practice Address - Country:US
Practice Address - Phone:800-516-8709
Practice Address - Fax:888-221-3183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZE0600X
IL1744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744R1102XOther Service ProvidersSpecialistResearch StudyGroup - Multi-Specialty
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty