Healthcare Provider Details

I. General information

NPI: 1275812182
Provider Name (Legal Business Name): MERCY HOSPITAL MEDICAL CENTRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 S MICHIGAN AVE MERCY HOSPITAL MEDICAL CENTER
CHICAGO IL
60616-2333
US

IV. Provider business mailing address

345 E EASTGATE PL APT 205
CHICAGO IL
60616-5504
US

V. Phone/Fax

Practice location:
  • Phone: 312-567-2000
  • Fax:
Mailing address:
  • Phone: 732-647-5708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number125059101
License Number StateIL

VIII. Authorized Official

Name: DR. VIDHYALAKSHMY VIVEK
Title or Position: RESIDENT PHYSICIAN
Credential: MD
Phone: 732-647-5708