Healthcare Provider Details

I. General information

NPI: 1912353822
Provider Name (Legal Business Name): ADVENTIST MIDWEST HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 COMMUNITY MEMORIAL DR
LA GRANGE IL
60525-2659
US

IV. Provider business mailing address

2601 NAVISTAR DR
LISLE IL
60532-3661
US

V. Phone/Fax

Practice location:
  • Phone: 708-245-8900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: CULLY CHAPMAN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 630-856-6062