Provider Demographics
NPI:1831238120
Name:SS MEDICAL SERVICES PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SS MEDICAL SERVICES PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SITARA
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHARIF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-968-1700
Mailing Address - Street 1:4121 FAIRVIEW AVE STE L2
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2275
Mailing Address - Country:US
Mailing Address - Phone:630-968-1700
Mailing Address - Fax:630-968-7103
Practice Address - Street 1:4121 FAIRVIEW AVE STE L2
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2275
Practice Address - Country:US
Practice Address - Phone:630-968-1700
Practice Address - Fax:630-968-7103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02228283OtherBCBS OF IL
ILK05023Medicare PIN
IL208650Medicare PIN