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General NPI Number Information
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NPI Number | 1780839746
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF CHICAGO
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Dates
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Enumeration Date | 11/18/2008
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Last Update Date | 11/18/2008
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Provider Practice Location Address
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Address Line | 5841 SOUTH MARYLAND MC 3026
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City | CHICAGO
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State | IL
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Zip | 60637
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Country | US
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Telephone | 773-702-2123
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Fax |
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Provider Business Mailing Address
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Address Line | 5841 SOUTH MARYLAND MC 3026
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City | CHICAGO
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State | IL
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Zip | 60637
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Country | US
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Telephone | 773-702-2123
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Fax |
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Authorized Official
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Title or Position | NEUROSURGEON
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Name | DAVID FRIM
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Credential | MD
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Telephone | 773-702-2123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 125054984
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License Number State | IL
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