MEDICARE: COOK COUNTY

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	261QS1000X	Student Health Clinic/Center	0004549	IL

General Provider Information

NPI Number	:	1972623528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COOK COUNTY

Provider Business Mailing Address
First Line	:	1110 S OAKLEY BLVD
Second Line	:	ROOM 200
City	:	CHICAGO
State	:	IL
Zip	:	60612-4218
Country	:	US
Telephone Number	:	312-864-4665
Fax Number	:

Provider Business Practice Location Address
First Line	:	4934 S WABASH AVE RM 165
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-2136
Country	:	US
Telephone Number	:	773-548-3651
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	SANDRA ANKEBRANT
Credential	:
Telephone Number	:	312-864-0719

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	08/22/2020

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Directions to “COOK COUNTY ” Practice Location

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