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General NPI Number Information
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NPI Number | 1912063439
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Entity Type | Organization
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Legal Business Name | COOK COUNTY
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 605 S WOLCOTT AVE, SUITE 605
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City | CHICAGO
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State | IL
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Zip | 60612
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Country | US
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Telephone | 312-864-4649
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Fax | 312-864-9763
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Provider Business Mailing Address
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Address Line | 15900 SOUTH CICERO AVENUE
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City | OAK FOREST
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State | IL
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Zip | 60452-4000
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Country | US
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Telephone | 708-633-3400
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Fax | 708-633-3407
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Authorized Official
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Title or Position | DIRECTOR OF MANAGED CARE OPERATIONS
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Name | SCOTT ANDRLE
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Credential |
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Telephone | 312-864-4649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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