MEDICARE: JOHN STROGER HOSPITAL OF COOK COUNTY

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	282NC0060X	Critical Access Hospital	036082665	IL

General Provider Information

NPI Number	:	1659475184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN STROGER HOSPITAL OF COOK COUNTY

Provider Business Mailing Address
First Line	:	2728 N HAMPDEN CT APT 605
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-6550
Country	:	US
Telephone Number	:	312-864-7250
Fax Number	:	312-864-9002

Provider Business Practice Location Address
First Line	:	2728 N HAMPDEN CT APT 605
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-6550
Country	:	US
Telephone Number	:	312-864-7250
Fax Number	:	312-864-9002

Authorized Official
Title or Position	:	ATTENDING PHYSICIAN
Name	:	AHMAD JAJEH
Credential	:	M.D.
Telephone Number	:	312-864-7250

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	07/23/2008

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