Healthcare Provider Details

I. General information

NPI: 1336709112
Provider Name (Legal Business Name): ADVOCATE HEALTH AND HOSPITALS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 W MADISON ST STE 3825
CHICAGO IL
60602-4500
US

IV. Provider business mailing address

PO BOX 102322
PASADENA CA
91189-2322
US

V. Phone/Fax

Practice location:
  • Phone: 312-219-2230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NAN NELSON
Title or Position: EVP FINANCIAL OPS
Credential:
Phone: 414-299-1610