MEDICARE: UNIVERSITY OF CHICAGO

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	261QH0100X	Health Service Clinic/Center	125054984	IL

General Provider Information

NPI Number	:	1780839746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF CHICAGO

Provider Business Mailing Address
First Line	:	5841 SOUTH MARYLAND
Second Line	:	MC 3026
City	:	CHICAGO
State	:	IL
Zip	:	60637
Country	:	US
Telephone Number	:	773-702-2123
Fax Number	:

Provider Business Practice Location Address
First Line	:	5841 SOUTH MARYLAND
Second Line	:	MC 3026
City	:	CHICAGO
State	:	IL
Zip	:	60637
Country	:	US
Telephone Number	:	773-702-2123
Fax Number	:

Authorized Official
Title or Position	:	NEUROSURGEON
Name	:	DAVID FRIM
Credential	:	MD
Telephone Number	:	773-702-2123

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	11/18/2008

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Directions to “UNIVERSITY OF CHICAGO ” Practice Location

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