Basic Information
| Provider Information | |||||||||
| NPI: | 1023308608 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVOCATE LUTHERAN GENERAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1775 W DEMPSTER ST | ||||||||
| Address2: | 8 SOUTH | ||||||||
| City: | PARK RIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600681143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477238077 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1775 W DEMPSTER ST | ||||||||
| Address2: | 8 SOUTH | ||||||||
| City: | PARK RIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600681143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477238077 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2011 | ||||||||
| LastUpdateDate: | 04/15/2011 | ||||||||
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| AuthorizedOfficialLastName: | MCKENNA | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIO MEDICAL EDUCATION | ||||||||
| AuthorizedOfficialTelephone: | 8477237325 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC2000X | Y | Hospitals | General Acute Care Hospital | Children |
No ID Information.