Basic Information
| Provider Information | |||||||||
| NPI: | 1073855623 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE UNIVERSITY OF CHICAGP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5721 S MARYLAND AVE | ||||||||
| Address2: | DEPARTMENT OF PEDIATRICS | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606371419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737026169 | ||||||||
| FaxNumber: | 7738347310 | ||||||||
| Practice Location | |||||||||
| Address1: | 5841 S MARYLAND AVE MC6082 | ||||||||
| Address2: | UNIVERSITY OF CHICAGO | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606371419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737026169 | ||||||||
| FaxNumber: | 7738347310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2013 | ||||||||
| LastUpdateDate: | 03/21/2013 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | SECTION CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 7738340497 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC2000X | 036100327 | IL | Y | Hospitals | General Acute Care Hospital | Children |
No ID Information.