WAVELAND MEDICAL CENTER SC (NPI# 1407996622) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407996622 |
| Entity Type | Organization |
| Organization Name | WAVELAND MEDICAL CENTER SC |
| Practice Address |
840 W Irving Park Rd #201 Chicago IL 60613-3011 |
| Practice Telephone | 7739354470 |
| Practice Fax Number | 7739355598 |
| Mailing Telephone | 7739354470 |
| Mailing Fax Number | 7739355598 |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2009-10-05 |
| Authorized Official Name | DR. DANIEL C SHIN (PHYSICIAN) |
| Authorized Official Telephone | 7739354470 |
| Authorized Official Credential | M.D |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 213E00000X | Podiatrist | Podiatric Medicine & Surgery Service Providers | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Street Address |
840 W IRVING PARK RD #201 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60613-3011 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346298932 | Chicago Prosthetics, Inc | Durable Medical Equipment & Medical Supplies | 840 W Irving Park Rd, Suite 207, Chicago, IL 60613-3011 | 2006-05-05 |
| 1598282329 | Damian Janusz Skalak | Physical Therapist | 840 W Irving Park Rd, Chicago, IL 60613-3011 | 2017-08-23 |
| 1215395652 | Joelle Jackson | Nurse Practitioner | 840 W Irving Park Rd, Suite 301, Chicago, IL 60613-3011 | 2016-01-30 |
| 1356707111 | Lubov Bakman | Clinical Nurse Specialist | 840 W Irving Park Rd, 301, Chicago, IL 60613-3011 | 2016-01-10 |
| 1588030373 | Grezelro Gonzales | Nurse Practitioner | 840 W Irving Park Rd, 301, Chicago, IL 60613-3011 | 2015-08-15 |
| 1124412168 | Katie Rahoi | Registered Nurse | 840 W Irving Park Rd, Ste 301, Chicago, IL 60613-3011 | 2015-03-27 |
| 1083005268 | Zivile Calderon | Nurse Practitioner | 840 W Irving Park Rd, Ste 301, Chicago, IL 60613-3011 | 2015-02-10 |
| 1720478829 | Christian De Guia | Nurse Practitioner | 840 W Irving Park Rd, Ste 301, Chicago, IL 60613-3011 | 2015-01-27 |
| 1871983288 | Erin Lark | Nurse Practitioner | 840 W Irving Park Rd, Suite 301, Chicago, IL 60613-3011 | 2015-01-23 |
| 1295159846 | Michele Bey | Nurse Practitioner | 840 W Irving Park Rd, Ste 301, Chicago, IL 60613-3011 | 2014-02-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588261978 | Thorek Radiology Group Nfp | Radiology | 850 West Irving Park Road, Chicago, IL 60613 | 2020-10-08 |
| 1760034128 | Maryellen Karas Lajeunesse | Social Worker | 3930 N. Pine Grove Ave, #2403, Chicago, IL 60613 | 2019-07-15 |
| 1801366430 | Stephanie A Dykema | Psychologist | 4043 N Ravenswood Ave Suite 302, Chicago, IL 60613 | 2018-11-27 |
| 1487154191 | Alan Tsang | Counselor | 655 W Irving Park Rd Ste 203, Chicago, IL 60613 | 2018-02-19 |
| 1972015782 | Integrated Ortho, LLC. | Durable Medical Equipment & Medical Supplies | 3717 N. Ravenswood Ave, Suite 219w, Chicago, IL 60613 | 2017-11-02 |
| 1073048005 | Claire Jolly | Social Worker | 3701 N Ravenswood Ave Ste 301, Chicago, IL 60613 | 2017-04-27 |
| 1730626011 | Marc Fagan | Psychologist | 4101 N Ravenswood Ave., Chicago, IL 60613 | 2017-01-25 |
| 1205385671 | Sara Turner | Psychologist | 3855 N Greenview Ave # 2a, Chicago, IL 60613 | 2016-09-27 |
| 1962955997 | Michelle Montero | Psychologist | 925 W Dakin St Apt 405, Chicago, IL 60613 | 2016-07-26 |
| 1063883494 | Athletico, Ltd | Physical Therapist | 3922 North Sheridan Rd, Chicago, IL 60613 | 2015-10-12 |
| Find all providers in zip 60613 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053911495 | Moataz Barkat | Family Medicine | 3315 W 66th Pl, Chicago, IL 60629-3427 | 2020-10-26 |
| 1558976589 | Jasmine Ashley Fowler | Family Medicine | 2416 N Lotus Ave, Chicago, IL 60639-1435 | 2020-09-15 |
| 1720699176 | Healing Hands Resource Center Streator | Family Medicine | 2128 S Central Park Ave, Chicago, IL 60623-3113 | 2020-08-10 |
| 1285251892 | Soe Lwin Oo | Family Medicine | 1625 E 75th St # 1, Chicago, IL 60649-3603 | 2020-06-30 |
| 1124645700 | Timothy Alan Williams Jr. | Family Medicine | 1625 E 75th St Fl 1, Chicago, IL 60649-3603 | 2020-06-30 |
| 1194340026 | Kaysha Lynne Ribao | Family Medicine | 2116 S Springfield Ave, Chicago, IL 60623-2465 | 2020-06-16 |
| 1932724341 | Toni Kurian | Family Medicine | 1550 S Indiana Ave Apt 407, Chicago, IL 60605-4822 | 2020-06-11 |
| 1528689486 | Thurman J Robertson | Family Medicine | 1950 W. Polk Street, 7th Floor, Chicago, IL 60612-3714 | 2020-05-01 |
| 1629697297 | Lyndsey Danielle Johnson | Family Medicine | 2804 W Walton St, Chicago, IL 60622-4450 | 2020-04-13 |
| 1730708884 | Iruoma Genevieve Nwangwu | Family Medicine | 1950 W Polk Street, Chicago, IL 60612-3714 | 2020-04-09 |
| Find all providers in CHICAGO | ||||
Please comment or provide details below to improve the information on WAVELAND MEDICAL CENTER SC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.