Basic Information
| Provider Information | |||||||||
| NPI: | 1497949903 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VHS OF ILL DBA MACNEAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 850 N STATE ST | ||||||||
| Address2: | APT 19H | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606108678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3129811406 | ||||||||
| FaxNumber: | 7087833656 | ||||||||
| Practice Location | |||||||||
| Address1: | 3231 S EUCLID AVE 5TH FL | ||||||||
| Address2: | DEPT OF FAMILY MEDICINE | ||||||||
| City: | BERWYN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087832000 | ||||||||
| FaxNumber: | 7087833656 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2007 | ||||||||
| LastUpdateDate: | 08/29/2007 | ||||||||
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| AuthorizedOfficialLastName: | RAJENDRAM | ||||||||
| AuthorizedOfficialFirstName: | WINSTON | ||||||||
| AuthorizedOfficialMiddleName: | DAYALAN | ||||||||
| AuthorizedOfficialTitleorPosition: | RESIDENT PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 7087832000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | IL | Y | Hospitals | General Acute Care Hospital |
No ID Information.