MEDICARE: MOUNT SINAI COMMUNITY FOUNDATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician		IL

General Provider Information

NPI Number	:	1649318148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNT SINAI COMMUNITY FOUNDATION

Provider Business Mailing Address
First Line	:	3537 PAYSPHERE CIR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-0035
Country	:	US
Telephone Number	:	708-786-2900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2720 W. 15TH
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-1647
Country	:	US
Telephone Number	:	773-257-6701
Fax Number	:

Authorized Official
Title or Position	:	CHIEF MEDICAL OFFICER
Name	:	DR. JOHN E VAZQUEZ
Credential	:	M.D.
Telephone Number	:	773-257-6850

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/21/2022

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Practice Fax:

Directions to “MOUNT SINAI COMMUNITY FOUNDATION ” Practice Location

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