Healthcare Provider Details

I. General information

NPI: 1780704163
Provider Name (Legal Business Name): COOK COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15900 S CICERO
OAK FOREST IL
60452
US

IV. Provider business mailing address

1110 S OAKLEY BLVD ROOM 200
CHICAGO IL
60612-4218
US

V. Phone/Fax

Practice location:
  • Phone: 708-633-2000
  • Fax:
Mailing address:
  • Phone: 312-864-4665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number0001743
License Number StateIL

VIII. Authorized Official

Name: SANDRA ANKEBRANT
Title or Position: COO
Credential:
Phone: 312-864-0719