Provider Demographics
NPI:1902695497
Name:MEDIVERSE PROFESSIONAL GROUP PLLC
Entity type:Organization
Organization Name:MEDIVERSE PROFESSIONAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:USMAN
Authorized Official - Middle Name:KAREEM
Authorized Official - Last Name:QADEER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-800-1646
Mailing Address - Street 1:1S131 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3904
Mailing Address - Country:US
Mailing Address - Phone:574-800-1646
Mailing Address - Fax:
Practice Address - Street 1:1S131 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3904
Practice Address - Country:US
Practice Address - Phone:574-800-1646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty