MEDICARE: MOUNT SINAI 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	282NC2000X	Children's Hospital		IL

General Provider Information

NPI Number	:	1659545986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNT SINAI MEDICAL CENTER

Provider Business Mailing Address
First Line	:	CALIFORNIA AVE AT 15TH ST.
Second Line	:	F44
City	:	CHICAGO
State	:	IL
Zip	:	60608
Country	:	US
Telephone Number	:	773-257-6183
Fax Number	:

Provider Business Practice Location Address
First Line	:	5030 N RIDGEWAY AVE UNIT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-6022
Country	:	US
Telephone Number	:	773-257-6183
Fax Number	:

Authorized Official
Title or Position	:	HOUSE STAFF RESIDENT PL-3
Name	:	DR. MELISSA PENETRANTE MANAIG
Credential	:	M.D.
Telephone Number	:	773-257-1885

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	04/17/2008

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