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General NPI Number Information
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NPI Number | 1063504165
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Entity Type | Organization
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Legal Business Name | LOYOLA UNIVERSITY MEDICAL CENTER
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 2160 S FIRST AVE
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 708-216-9000
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Fax | 708-216-0593
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Provider Business Mailing Address
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Address Line | 2160 S FIRST AVE
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 708-216-3510
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Fax | 708-216-0593
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MELISSA M LUKASICK
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Credential |
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Telephone | 708-216-5723
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2472R0900X
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Taxonomy Name | Renal Dialysis Technician
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License Number | 0004630
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 0005801
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 0005801
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License Number State | IL
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