Healthcare Provider Details

I. General information

NPI: 1770557951
Provider Name (Legal Business Name): MICHAEL REESE MEDICAL CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 S ELLIS AVE
CHICAGO IL
60616-3395
US

IV. Provider business mailing address

2929 S ELLIS AVE
CHICAGO IL
60616-3395
US

V. Phone/Fax

Practice location:
  • Phone: 312-791-2000
  • Fax: 312-791-2252
Mailing address:
  • Phone: 312-791-2000
  • Fax: 312-791-2252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number0004986
License Number StateIL

VIII. Authorized Official

Name: MRS. MARY ANN MEADE
Title or Position: DIRECTOR REVENUE CYCLE
Credential:
Phone: 312-791-3132