Provider Demographics
NPI:1932380649
Name:REEMS CLINIC & INSTITUTE OF MEDICINE S.C.
Entity Type:Organization
Organization Name:REEMS CLINIC & INSTITUTE OF MEDICINE S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YASEEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:ODEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-432-1707
Mailing Address - Street 1:1544 W CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622
Mailing Address - Country:US
Mailing Address - Phone:312-432-1707
Mailing Address - Fax:
Practice Address - Street 1:7251 W 87TH STREET
Practice Address - Street 2:
Practice Address - City:BRIDGEVIEW
Practice Address - State:IL
Practice Address - Zip Code:60455
Practice Address - Country:US
Practice Address - Phone:708-599-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036083325Medicaid