Organization
DIVERSEY MEDICAL CENTER SC
Active
Organization
DIVERSEY MEDICAL CENTER SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AREF SENNO MD (OWNER)
(773) 508-9800
Entity
Organization
Contact information
Practice address
2320 W PETERSON AVENUE, CHICAGO, IL 60659-5242
(773) 508-9800
(773) 508-1796
Mailing address
2320 W PETERSON AVENUE, CHICAGO, IL 60659-5242
(773) 508-9800
(773) 508-1796
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RG0100X
Gastroenterology Physician
—
—
207W00000X
Ophthalmology Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
213E00000X
Podiatrist
—
—
225100000X
Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01616720
BCBS
—
Enumeration date
08/04/2006
Last updated
04/20/2008
Update your record
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