Healthcare Provider Details

I. General information

NPI: 1124724919
Provider Name (Legal Business Name): LURIE CHILDREN'S HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 N WILKE RD STE H
ARLINGTON HEIGHTS IL
60004-1450
US

IV. Provider business mailing address

225 E CHICAGO AVE # 44
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 847-255-8690
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER MILLER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 312-227-1520