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General NPI Number Information
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NPI Number | 1518088319
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Entity Type | Organization
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Legal Business Name | LURIE CHILDREN'S MEDICAL GROUP
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 07/09/2013
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Provider Practice Location Address
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Address Line | 467 W DEMING PL SUITE 900
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City | CHICAGO
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State | IL
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Zip | 60614-1881
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Country | US
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Telephone | 773-327-2950
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Fax |
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Provider Business Mailing Address
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Address Line | 225 E CHICAGO AVE #64
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City | CHICAGO
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State | IL
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Zip | 60611-2991
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Country | US
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Telephone | 312-227-7200
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Fax | 312-227-9150
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Authorized Official
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Title or Position | CFO
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Name | PAULA NOBLE
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Credential |
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Telephone | 312-227-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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