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General NPI Number Information
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NPI Number | 1083040786
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Entity Type | Organization
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Legal Business Name | ILLINOIS MASONIC HOSPITAL
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Dates
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Enumeration Date | 09/25/2013
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Last Update Date | 09/25/2013
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Provider Practice Location Address
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Address Line | 3048 N WILTON AVE 3RD FLOOR
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City | CHICAGO
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State | IL
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Zip | 60657-6710
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Country | US
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Telephone | 773-296-3098
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Fax |
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Provider Business Mailing Address
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Address Line | 3048 N WILTON AVE 3RD FLOOR
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City | CHICAGO
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State | IL
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Zip | 60657-6710
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SUPERVISOR OF CNM SERVICES
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Name | LISE HAUSER
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Credential | CNM
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Telephone | 773-296-3098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NW0100X
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Taxonomy Name | Women's Hospital
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License Number | 209.010657
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License Number State | IL
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