Healthcare Provider Details

I. General information

NPI: 1497949903
Provider Name (Legal Business Name): VHS OF ILL DBA MACNEAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 S EUCLID AVE 5TH FL DEPT OF FAMILY MEDICINE
BERWYN IL
60402
US

IV. Provider business mailing address

850 N STATE ST APT 19H
CHICAGO IL
60610-8678
US

V. Phone/Fax

Practice location:
  • Phone: 708-783-2000
  • Fax: 708-783-3656
Mailing address:
  • Phone: 312-981-1406
  • Fax: 708-783-3656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. WINSTON DAYALAN RAJENDRAM
Title or Position: RESIDENT PHYSICIAN
Credential: M.D.
Phone: 708-783-2000