Healthcare Provider Details

I. General information

NPI: 1093567000
Provider Name (Legal Business Name): MOUNT SINAI COMMUNITY FOUNDATION DBA SINAI MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W 68TH ST
CHICAGO IL
60629-1813
US

IV. Provider business mailing address

26460 NETWORK PL
CHICAGO IL
60673-1264
US

V. Phone/Fax

Practice location:
  • Phone: 773-849-9000
  • Fax:
Mailing address:
  • Phone: 773-257-1688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER SPROWL
Title or Position: CHIEF MEDICAL OFFICER
Credential:
Phone: 773-257-4320