Healthcare Provider Details

I. General information

NPI: 1144473745
Provider Name (Legal Business Name): ADRIENNE M BURFORD-FOGGS MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E ERIE ST STE 701
CHICAGO IL
60611-5933
US

IV. Provider business mailing address

233 E ERIE ST STE 701
CHICAGO IL
60611-5933
US

V. Phone/Fax

Practice location:
  • Phone: 312-664-4000
  • Fax: 312-664-4006
Mailing address:
  • Phone: 312-664-4000
  • Fax: 312-664-4006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number036072741
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. ADRIENNE M BURFORD-FOGGS MD SC
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 312-926-0551