Healthcare Provider Details

I. General information

NPI: 1033021787
Provider Name (Legal Business Name): UNIVERSITY OF CHICAGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE UCPG/ MC 1099
CHICAGO IL
60637-1447
US

IV. Provider business mailing address

150 HARVESTER DR STE 300
BURR RIDGE IL
60527-5965
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-9200
  • Fax:
Mailing address:
  • Phone: 773-702-6400
  • Fax: 773-702-0000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARY JEAN OSTRANDER
Title or Position: MANAGER - PROVIDER ENROLLMENT
Credential:
Phone: 773-834-4508