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General NPI Number Information
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NPI Number | 1801038302
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Entity Type | Organization
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Legal Business Name | CHILDREN'S MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 03/30/2009
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Last Update Date | 03/30/2009
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Provider Practice Location Address
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Address Line | 2300 N CHILDRENS PLZ # 18
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City | CHICAGO
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State | IL
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Zip | 60614-3363
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Country | US
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Telephone | 773-880-4302
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Fax |
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Provider Business Mailing Address
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Address Line | 117 FERSON AVE
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City | IOWA CITY
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State | IA
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Zip | 52246-3505
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Country | US
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Telephone | 816-807-3883
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Fax |
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Authorized Official
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Title or Position | RESIDENCY PROGRAM COORDINATOR
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Name | LINDA GROBLE
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Credential |
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Telephone | 773-880-4302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | IL
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