Healthcare Provider Details

I. General information

NPI: 1194910125
Provider Name (Legal Business Name): CITY OF CHICAGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2849 N CLARK ST LAKEVIEW N H C
CHICAGO IL
60657
US

IV. Provider business mailing address

111 W WASHINGTON ST FL 4
CHICAGO IL
60602-2703
US

V. Phone/Fax

Practice location:
  • Phone: 312-744-7448
  • Fax: 312-747-9447
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: HILLARY WANG
Title or Position: PROJECTS MANAGER
Credential:
Phone: 312-747-8875