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General NPI Number Information
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NPI Number | 1194164202
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Entity Type | Organization
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Legal Business Name | OAK STREET HEALTH: EDGEWATER
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Dates
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Enumeration Date | 06/21/2013
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Last Update Date | 06/21/2013
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Provider Practice Location Address
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Address Line | 1541 W DEVON AVE
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City | CHICAGO
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State | IL
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Zip | 60660-1313
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Country | US
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Telephone | 312-810-8763
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Fax |
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Provider Business Mailing Address
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Address Line | 327 W BELDEN AVE #3
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City | CHICAGO
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State | IL
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Zip | 60614-3817
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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 | CHIEF MEDICAL OFFICER
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Name | DR. GRIFFIN MYERS
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Credential | M.D.
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Telephone | 773-412-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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