Provider Demographics
NPI:1871712612
Name:GIVEN, REEM I (PT)
Entity type:Individual
Prefix:
First Name:REEM
Middle Name:I
Last Name:GIVEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:REEM
Other - Middle Name:A
Other - Last Name:ISMAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:
Practice Address - Street 1:6759 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2607
Practice Address - Country:US
Practice Address - Phone:847-470-9995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011788225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619980OtherBCBS OF IL
ILR03275Medicare PIN
ILR03274Medicare PIN
IL568150Medicare PIN
ILL95304Medicare PIN
IL567700Medicare PIN
IL1619980OtherBCBS OF IL