1538497656 NPI number — CHICAGO UPTOWN MEDICAL CENTER

Table of content: (NPI 1538497656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538497656 NPI number — CHICAGO UPTOWN MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHICAGO UPTOWN MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1538497656
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2333 W IRVING PARK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60618-3838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-506-7340
Provider Business Mailing Address Fax Number:
773-506-7341

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10004 KENNERLY RD STE 335A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63128-2194
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-506-7340
Provider Business Practice Location Address Fax Number:
773-506-7341
Provider Enumeration Date:
12/01/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SUNJE
Authorized Official First Name:
LEJLA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
773-506-7340

Provider Taxonomy Codes

  • Taxonomy code: 202K00000X , with the licence number:  2006013537 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 2006013537 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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