Provider Demographics
NPI:1215049838
Name:OAK BROOK CENTER FOR HEALTH INC
Entity type:Organization
Organization Name:OAK BROOK CENTER FOR HEALTH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIANOOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-990-2212
Mailing Address - Street 1:2425 W 22ND ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-4641
Mailing Address - Country:US
Mailing Address - Phone:630-990-2212
Mailing Address - Fax:630-990-2441
Practice Address - Street 1:2425 W 22ND ST
Practice Address - Street 2:STE 215
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-4661
Practice Address - Country:US
Practice Address - Phone:630-581-5464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILR355-1014-7206207VG0400X
IL016004441213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL556280Medicare UPIN