Healthcare Provider Details

I. General information

NPI: 1932622529
Provider Name (Legal Business Name): HADI TOEG MD, MSC, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST STE 19-100
CHICAGO IL
60611
US

IV. Provider business mailing address

680 N LAKE SHORE DR
CHICAGO IL
60611-4546
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-6868
  • Fax:
Mailing address:
  • Phone: 312-695-6868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number61960
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number036146820
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: