Healthcare Provider Details

I. General information

NPI: 1861837718
Provider Name (Legal Business Name): ANN AND ROBERT H. LURIE CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 EAST CHICAGO AVE
CHICAGO IL
60611
US

IV. Provider business mailing address

9849 S. CLIFTON PARK AVE
EVERGREEN PARK IL
60805
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-4000
  • Fax:
Mailing address:
  • Phone: 773-317-1839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number209.009698041.348598
License Number StateIL

VIII. Authorized Official

Name: MRS. SYLVIA PEREZ SMITH
Title or Position: APN, MSN, CPNP
Credential: APN
Phone: 773-317-1839