Provider Demographics
NPI:1992927511
Name:PEARL MEDICAL CENTER S.C.
Entity type:Organization
Organization Name:PEARL MEDICAL CENTER S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUQSITA
Authorized Official - Middle Name:
Authorized Official - Last Name:NASHAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-506-1234
Mailing Address - Street 1:4926 N CHRISTIANA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-5004
Mailing Address - Country:US
Mailing Address - Phone:773-866-2182
Mailing Address - Fax:773-866-1182
Practice Address - Street 1:1945 W WILSON AVE STE 5115
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5258
Practice Address - Country:US
Practice Address - Phone:773-506-1234
Practice Address - Fax:773-506-1235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty