Provider Demographics
NPI:1053806406
Name:NAPERVILLE REHAB AND MEDICAL CLINIC PC
Entity type:Organization
Organization Name:NAPERVILLE REHAB AND MEDICAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMBIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGHSOUDI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-961-1888
Mailing Address - Street 1:1750 N WASHINGTON ST STE 112C
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-4850
Mailing Address - Country:US
Mailing Address - Phone:630-961-1888
Mailing Address - Fax:773-337-9106
Practice Address - Street 1:1750 N WASHINGTON ST STE 112C
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-4850
Practice Address - Country:US
Practice Address - Phone:630-961-1888
Practice Address - Fax:773-337-9106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360815812081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty