Healthcare Provider Details

I. General information

NPI: 1073743209
Provider Name (Legal Business Name): ERNESTINE HAMBRICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 S DAMEN AVE SUITE 200
CHICAGO IL
60608-1169
US

IV. Provider business mailing address

1340 S DAMEN AVE SUITE 200
CHICAGO IL
60608-1169
US

V. Phone/Fax

Practice location:
  • Phone: 312-997-7200
  • Fax: 312-997-7250
Mailing address:
  • Phone: 312-997-7200
  • Fax: 312-997-7250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number036.042220
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: