Provider Demographics
NPI:1427128271
Name:BADR, MEDHAT
Entity type:Individual
Prefix:
First Name:MEDHAT
Middle Name:
Last Name:BADR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8046 S COTTAGE GROVE AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-4004
Mailing Address - Country:US
Mailing Address - Phone:708-479-6522
Mailing Address - Fax:708-479-6597
Practice Address - Street 1:1701 CATON RIDGE DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-5635
Practice Address - Country:US
Practice Address - Phone:708-479-6522
Practice Address - Fax:708-479-6597
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist