MEDICARE: CHICAGO UPTOWN 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
1	202K00000X	Phlebology Physician	036103665	IL
2	207R00000X	Internal Medicine Physician	036103665	IL

General Provider Information

NPI Number	:	1255427704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO UPTOWN MEDICAL CENTER

Provider Business Mailing Address
First Line	:	2333 W IRVING PARK RD STE 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3838
Country	:	US
Telephone Number	:	773-506-7340
Fax Number	:	773-506-7341

Provider Business Practice Location Address
First Line	:	4906 N WESTERN AVE
Second Line	:	SUITE 1
City	:	CHICAGO
State	:	IL
Zip	:	60625
Country	:	US
Telephone Number	:	773-506-7340
Fax Number	:	773-506-7341

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. LEJLA M. SUNJE
Credential	:	MBA
Telephone Number	:	773-506-7340

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	02/26/2021

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Directions to “CHICAGO UPTOWN MEDICAL CENTER ” Practice Location

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