Healthcare Provider Details

I. General information

NPI: 1548499338
Provider Name (Legal Business Name): JOHN STROGER JR. HOSPITAL OF COOK COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 W HARRISON ST UNIT 2
CHICAGO IL
60612-3476
US

IV. Provider business mailing address

2503 W HARRISON ST UNIT 2
CHICAGO IL
60612-3476
US

V. Phone/Fax

Practice location:
  • Phone: 330-962-5619
  • Fax:
Mailing address:
  • Phone: 330-962-5619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License Number125053765
License Number StateIL

VIII. Authorized Official

Name: DR. NORELL ROSADO
Title or Position: PROGRAM DIRECTOR
Credential: MD
Phone: 312-864-4505