Healthcare Provider Details

I. General information

NPI: 1538254107
Provider Name (Legal Business Name): SAINT JOSEPH HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N LAKE SHORE DRIVE 1ST FLOOR CLINIC
CHICAGO IL
60657
US

IV. Provider business mailing address

2900 N LAKE SHORE DRIVE 1ST FLOOR CLINIC
CHICAGO IL
60657
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-3211
  • Fax: 773-665-3498
Mailing address:
  • Phone: 773-665-3211
  • Fax: 773-665-3498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN STEINER
Title or Position: DIRECTOR, MEDICAL STAFF OFFICE
Credential:
Phone: 773-665-3308