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General NPI Number Information
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NPI Number | 1669603528
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Entity Type | Organization
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Legal Business Name | JESSE BROWN VETERANS ADMINISTRATION
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Dates
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Enumeration Date | 07/27/2009
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1400 S MICHIGAN AVE TOWER II, UNIT 1907
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City | CHICAGO
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State | IL
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Zip | 60605-3714
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Country | US
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Telephone | 773-988-5833
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 S MICHIGAN AVENUE TOWER II, UNIT 1907
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City | CHICAGO
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State | IL
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Zip | 60605
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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 | MEDICAL RESIDENT
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Name | JULIANA LLAZAR BASKO
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Credential | MD
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Telephone | 773-988-5833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State | IL
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