1568886422 NPI number — JONATHAN WILLARD BUSH M.D.

Table of content: JONATHAN WILLARD BUSH M.D. (NPI 1568886422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568886422 NPI number — JONATHAN WILLARD BUSH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUSH
Provider First Name:
JONATHAN
Provider Middle Name:
WILLARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568886422
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 E CHICAGO AVE
Provider Second Line Business Mailing Address:
LURIE CHILDREN'S HOSPITAL, BOX 17, DEPT OF PATHOLOGY
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60611-2991
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-227-3973
Provider Business Mailing Address Fax Number:
312-227-9616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 E CHICAGO AVE
Provider Second Line Business Practice Location Address:
LURIE CHILDREN'S HOSPITAL, BOX 17, DEPT OF PATHOLOGY
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60611-2991
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-227-3973
Provider Business Practice Location Address Fax Number:
312-227-9616
Provider Enumeration Date:
02/13/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0213X , with the licence number:  036134248 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)