Healthcare Provider Details

I. General information

NPI: 1245530351
Provider Name (Legal Business Name): EPILEPSY FOUNDATION OF GREATER CHICAGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 N STATE ST SUITE 1300
CHICAGO IL
60602-3315
US

IV. Provider business mailing address

17 N. STATE ST. SUITE 1300
CHICAGO IL
60602-3297
US

V. Phone/Fax

Practice location:
  • Phone: 312-939-8622
  • Fax: 312-939-0391
Mailing address:
  • Phone: 312-939-8622
  • Fax: 312-939-0391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. PHIL M GATTONE
Title or Position: PRESIDENT & CEO
Credential: M.ED
Phone: 312-939-8622