Healthcare Provider Details

I. General information

NPI: 1568777852
Provider Name (Legal Business Name): JOHN H STROGER HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 S WOOD ST RM 832A
CHICAGO IL
60612-3821
US

IV. Provider business mailing address

2057 MARK CIR
BOLINGBROOK IL
60490-4916
US

V. Phone/Fax

Practice location:
  • Phone: 312-333-8779
  • Fax: 312-864-9725
Mailing address:
  • Phone: 510-828-8746
  • Fax: 312-864-9725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. HERMINA KUNG JEON
Title or Position: INTERNAL MEDICINE/RESIDENT
Credential:
Phone: 510-828-8746