MEDICARE: UNIVERSITY OF CHICAGO COMER CHILDREN'S HOSPITAL

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	261QM2500X	Medical Specialty Clinic/Center		IL

General Provider Information

NPI Number	:	1497967491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF CHICAGO COMER CHILDREN'S HOSPITAL

Provider Business Mailing Address
First Line	:	5841 S MARYLAND AVE
Second Line	:	MC 4060
City	:	CHICAGO
State	:	IL
Zip	:	60637
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5841 S MARYLAND AVE
Second Line	:	MC 4060
City	:	CHICAGO
State	:	IL
Zip	:	60637
Country	:	US
Telephone Number	:	773-702-6808
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL ASSOCIATE
Name	:	RUTH RETONDO-RUDINSKY
Credential	:	MD
Telephone Number	:	773-702-6808

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	08/22/2020

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