Healthcare Provider Details

I. General information

NPI: 1962899690
Provider Name (Legal Business Name): MR. JOHN PRICE CALDWELL JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2015
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST STE 16-738
CHICAGO IL
60611-3055
US

IV. Provider business mailing address

251 E HURON ST STE 16-738
CHICAGO IL
60611-3055
US

V. Phone/Fax

Practice location:
  • Phone: 847-234-5600
  • Fax: 847-535-7203
Mailing address:
  • Phone: 847-234-5600
  • Fax: 847-535-7203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036158058
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number274477
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: