Healthcare Provider Details

I. General information

NPI: 1053612275
Provider Name (Legal Business Name): SAINT JOSEPH HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N. LAKESHORE
CHICAGO IL
60614
US

IV. Provider business mailing address

2828 N CAMBRIDGE AVE APT 406
CHICAGO IL
60657-6051
US

V. Phone/Fax

Practice location:
  • Phone: 773-665-3000
  • Fax:
Mailing address:
  • Phone: 773-715-1934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number125058676
License Number StateIL

VIII. Authorized Official

Name: AHMAD ALWAKKAF
Title or Position: MD
Credential:
Phone: 773-715-1934