Healthcare Provider Details

I. General information

NPI: 1942413752
Provider Name (Legal Business Name): JOSHUA MARK HAUSER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

750 N LAKE SHORE DR SUITE 601
CHICAGO IL
60611-3152
US

V. Phone/Fax

Practice location:
  • Phone: 312-503-3478
  • Fax: 312-503-5868
Mailing address:
  • Phone: 312-503-3478
  • Fax: 312-503-5868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number036098497
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36-098497
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: