Basic Information
| Provider Information | |||||||||
| NPI: | 1508198383 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAINT JOSEPH HOSPITAL | ||||||||
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| OtherOrganizationName: | NEUROSURGICAL SERVICES - DR. ROGER LICHTENBAUM | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1431 N WESTERN AVE | ||||||||
| Address2: | SUITE 306 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606221797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3123322226 | ||||||||
| FaxNumber: | 7732761197 | ||||||||
| Practice Location | |||||||||
| Address1: | 2800 N SHERIDAN RD | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606576156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3123322226 | ||||||||
| FaxNumber: | 7732761197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2010 | ||||||||
| LastUpdateDate: | 02/04/2010 | ||||||||
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| AuthorizedOfficialLastName: | STEINER | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR PHYS SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 7736653000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.