Burbank Medical Group Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036088926 Issued in IL

Legal business name

BURBANK MEDICAL GROUP INC

Practice address

4817 W 83Rd St
Burbank, IL 60429

Phone

(708) 425-3135

Fax

(708) 425-6884

NPI assigned

Mar 8, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jalal Dahshe, MDNPI 1790716967

Title

Provider

Phone

(708) 425-3135

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jalal Dahshe, MD

  • Internal Medicine Physician
  • Burbank, IL
  • NPI 1790716967

  IL, Internal Medicine

  Medicare reassignment NPD Authorized official
• Shuja Abbas, DPM

  • Foot & Ankle Surgery Podiatrist
  • Chicago, IL
  • NPI 1891375598
  NPD
• Shayan Alamgir, DPM

  • Foot & Ankle Surgery Podiatrist
  • Aurora, IL
  • NPI 1841729084
  NPD
• Fahad Tahir, DPM

  • Foot & Ankle Surgery Podiatrist
  • Aurora, IL
  • NPI 1851968481
  NPD
• Mitchell Drexler, DPM MPH

  • Podiatrist
  • Burbank, IL
  • NPI 1922021674
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1362700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362700800000",
    "number": "1508107061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9229 MASSASOIT AVE",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "60453",
            "telephone_number": "708-422-2023",
            "fax_number": "708-423-2991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4817 W 83RD ST",
            "city": "BURBANK",
            "state": "IL",
            "postal_code": "60429",
            "telephone_number": "708-425-3135",
            "fax_number": "708-425-6884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BURBANK MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-08",
        "last_updated": "2013-03-08",
        "status": "A",
        "authorized_official_last_name": "DAHSHE",
        "authorized_official_first_name": "JALAL",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "708-425-3135",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036088926",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "030088926",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaylan Brown
• Tatiana Vitalia Buonicore, APRN-FPA
• Burbank Clinics Inc
• Burbank Dental
• Burbank Medical Center SC
• Burbank Pharmacy LLC
• Burbank Rehabilitation Center, LLC
• Rebecca Marie Burke
• Kimberly Caceres
• Isabel A Calderon

• All providers in Burbank, IL
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.