Healthcare Provider Details

I. General information

NPI: 1417959800
Provider Name (Legal Business Name): CITY OF CHICAGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 S ASHLAND AVE
CHICAGO IL
60608-2014
US

IV. Provider business mailing address

111 W WASHINGTON ST FL 4
CHICAGO IL
60602-2703
US

V. Phone/Fax

Practice location:
  • Phone: 312-746-5157
  • Fax: 312-746-7478
Mailing address:
  • Phone: 312-747-9443
  • Fax: 312-747-9447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MATTHEW W. BEAUDET
Title or Position: FIRST DEPUTY COMMISSIONER
Credential:
Phone: 312-747-9889