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General NPI Number Information
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NPI Number | 1982852091
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Entity Type | Organization
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Legal Business Name | LOYOLA UNIVERSITY MEDICAL CENTER
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 09/03/2008
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Provider Practice Location Address
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Address Line | 1603 SOUTH NORBURY AVENUE
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City | LOMBARD
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State | IL
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Zip | 60148
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Country | US
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Telephone | 630-495-6766
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Fax |
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Provider Business Mailing Address
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Address Line | 1603 SOUTH NORBURY AVENUE
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City | LOMBARD
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State | IL
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Zip | 60148
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Country | US
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Telephone | 630-495-6766
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | AYESHA WAHEED
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Credential |
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Telephone | 630-495-6766
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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 | 036120661
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License Number State | IL
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