Healthcare Provider Details

I. General information

NPI: 1255250890
Provider Name (Legal Business Name): MCDERMOTT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

954 W WASHINGTON BLVD
CHICAGO IL
60607-2224
US

IV. Provider business mailing address

932 W WASHINGTON BLVD
CHICAGO IL
60607-2217
US

V. Phone/Fax

Practice location:
  • Phone: 312-226-7984
  • Fax: 312-980-0482
Mailing address:
  • Phone: 312-226-7984
  • Fax: 312-980-0482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAN S LUSTIG
Title or Position: PRESIDENT
Credential:
Phone: 312-226-7984