Healthcare Provider Details

I. General information

NPI: 1043584865
Provider Name (Legal Business Name): CHRISTIAN JOSE ASCOLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2012
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF ILLINOIS CENTER FOR LUNG HEALTH 1801 W TAYLOR, SUITE 3C
CHICAGO IL
60612-4325
US

IV. Provider business mailing address

840 S WOOD ST RM 920-N
CHICAGO IL
60612-4325
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-2740
  • Fax:
Mailing address:
  • Phone: 312-996-8039
  • Fax: 312-996-4665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number60 270948
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036134847
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036134847
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: