Basic Information
| Provider Information | |||||||||
| NPI: | 1497907786 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY OF CHICAGO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 HARVESTER DR STE 110 | ||||||||
| Address2: | |||||||||
| City: | BURR RIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605276686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738341061 | ||||||||
| FaxNumber: | 7738340946 | ||||||||
| Practice Location | |||||||||
| Address1: | 5841 S MARYLAND AVE # MC3077 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606371447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7737026751 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2008 | ||||||||
| LastUpdateDate: | 10/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | VELAZQUEZ | ||||||||
| AuthorizedOfficialFirstName: | ZORAYA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 7738341061 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 036051478 | IL | Y | Hospitals | General Acute Care Hospital |
No ID Information.