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General NPI Number Information
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NPI Number | 1073855623
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Entity Type | Organization
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Legal Business Name | THE UNIVERSITY OF CHICAGP
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Dates
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Enumeration Date | 03/21/2013
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Last Update Date | 03/21/2013
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Provider Practice Location Address
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Address Line | 5841 S MARYLAND AVE MC6082 UNIVERSITY OF CHICAGO
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City | CHICAGO
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State | IL
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Zip | 60637-1419
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Country | US
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Telephone | 773-702-6169
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Fax | 773-834-7310
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Provider Business Mailing Address
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Address Line | 5721 S MARYLAND AVE DEPARTMENT OF PEDIATRICS
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City | CHICAGO
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State | IL
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Zip | 60637-1419
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Country | US
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Telephone | 773-702-6169
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Fax | 773-834-7310
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Authorized Official
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Title or Position | SECTION CHIEF
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Name | DR. DANIEL JOHNSON
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Credential | M.D.
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Telephone | 773-834-0497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC2000X
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Taxonomy Name | Children's Hospital
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License Number | 036100327
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License Number State | IL
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