=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932377694
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEKTOEN INSTITUTE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2008
-----------------------------------------------------
Last Update Date | 02/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 WEST POLK STREET COOK COUNTY HOSPITAL
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60612-9987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-864-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2100 WEST HARRISON STREET
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60612-9987
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-948-2500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. DENNIS RONOWSKI
-----------------------------------------------------
Credential | MBA, CPA
-----------------------------------------------------
Telephone | 312-948-2530
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------