Healthcare Provider Details

I. General information

NPI: 1518021153
Provider Name (Legal Business Name): CITY OF CHICAGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 W. OGDEN WESTSIDE C.D.C
CHICAGO IL
60604
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 312-747-9792
  • Fax: 312-747-9447
Mailing address:
  • Phone: 312-747-9792
  • Fax: 312-767-9447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SARAI M. JACKSON
Title or Position: DIRECTOR OF REVENUE
Credential: DIRECTOR
Phone: 312-747-9792