Healthcare Provider Details

I. General information

NPI: 1497830376
Provider Name (Legal Business Name): CHICAGO DEPARTMENT OF PUBLIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2418 W DIVISION ST
CHICAGO IL
60622-2940
US

IV. Provider business mailing address

3519 W WRIGHTWOOD AVE
CHICAGO IL
60647-1248
US

V. Phone/Fax

Practice location:
  • Phone: 312-744-7448
  • Fax: 312-744-5516
Mailing address:
  • Phone: 773-395-9314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. DANIEL VITTUM
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 312-744-7448