Healthcare Provider Details

I. General information

NPI: 1497018154
Provider Name (Legal Business Name): ANN AND ROBERT H LURIE CHILDRENS HOSPITAL OF CHICAGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2605
US

IV. Provider business mailing address

225 E CHICAGO AVE
CHICAGO IL
60611-2605
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License Number209008846
License Number StateIL

VIII. Authorized Official

Name: BARBABA DEAL
Title or Position: DIVISION CHIEF OF CARDIOLOGY
Credential:
Phone: 312-227-4000