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NPI Code Detail

MEDICARE: LOYOLA UNIVERSITY MEDICAL CENTER

MEDICARE: LOYOLA UNIVERSITY MEDICAL CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12472R0900XRenal Dialysis Technician0004630IL
2282N00000XGeneral Acute Care Hospital0005801IL
3261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center0005801IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
20564080001OTHERILMEDICARE HOME INFUSION

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11671580OTHERILBC FEDERAL HOME HEALTH
39729OTHERILBLUE CROSS HOME INFUSION
4500OTHERILBLUE CROSS

General Provider Information

NPI Number : 1063504165
Entity Type Code : Organization
Provider Name (Legal Business Name) : LOYOLA UNIVERSITY MEDICAL CENTER
Provider Business Mailing Address
First Line : 2160 S FIRST AVE
Second Line :
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number : 708-216-3510
Fax Number : 708-216-0593
Provider Business Practice Location Address
First Line : 2160 S FIRST AVE
Second Line :
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number : 708-216-9000
Fax Number : 708-216-0593
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : MELISSA M LUKASICK
Credential :
Telephone Number : 708-216-5723
Provider Enumeration Date : 09/28/2006
Last Update Date : 06/16/2025

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1306940705 — DR. STANLEY I KIM MD
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Directions to “LOYOLA UNIVERSITY MEDICAL CENTER ” Practice Location

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