Healthcare Provider Details

I. General information

NPI: 1487028825
Provider Name (Legal Business Name): PRESENCE CHICAGO HOSPITALS NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W NORTH AVE
CHICAGO IL
60610-1174
US

IV. Provider business mailing address

1000 REMINGTON BLVD SUITE 100
BOLINGBROOK IL
60440-5114
US

V. Phone/Fax

Practice location:
  • Phone: 312-337-1982
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN RASMUS
Title or Position: CFO
Credential:
Phone: 630-914-2468