Provider Demographics
NPI:1053439448
Name:BRIKHA MEDICAL CENTER SC
Entity type:Organization
Organization Name:BRIKHA MEDICAL CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRIKHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-692-5206
Mailing Address - Street 1:8118 N MILWAUKEE AVE
Mailing Address - Street 2:SUITE # 105
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2836
Mailing Address - Country:US
Mailing Address - Phone:847-692-5206
Mailing Address - Fax:847-692-5394
Practice Address - Street 1:8118 N MILWAUKEE AVE
Practice Address - Street 2:SUITE # 105
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-2836
Practice Address - Country:US
Practice Address - Phone:847-692-5206
Practice Address - Fax:847-692-5394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036097975174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036097975Medicaid
IL0031622648OtherBCBS
IL036107939Medicaid
IL1497707129OtherNPI
IL1396845848OtherNPI
IL1396845848OtherNPI
G89314Medicare UPIN