Provider Demographics
NPI:1962161315
Name:CAREND PROVIDER GROUP PA
Entity type:Organization
Organization Name:CAREND PROVIDER GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AWSS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-630-1534
Mailing Address - Street 1:2045 W GRAND AVE STE B #47606
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-1577
Mailing Address - Country:US
Mailing Address - Phone:708-630-1534
Mailing Address - Fax:
Practice Address - Street 1:3752 N SHEFFIELD AVE APT 3S
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-0305
Practice Address - Country:US
Practice Address - Phone:708-630-1534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-14
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty