Healthcare Provider Details

I. General information

NPI: 1043540503
Provider Name (Legal Business Name): COOK COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W HARRISON ST
CHICAGO IL
60612
US

IV. Provider business mailing address

1926 W HARRISON ST APT 1702
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-6000
  • Fax:
Mailing address:
  • Phone: 773-440-6689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number125056263
License Number StateIL

VIII. Authorized Official

Name: TRUPTI VASANTRAO KALE
Title or Position: RESIDENT PHYSICIAN
Credential: M.D.
Phone: 773-440-6689