Basic Information
| Provider Information | |||||||||
| NPI: | 1538254107 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAINT JOSEPH HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SJH CARDIOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2900 N LAKE SHORE DRIVE | ||||||||
| Address2: | 1ST FLOOR CLINIC | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7736653211 | ||||||||
| FaxNumber: | 7736653498 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 N LAKE SHORE DRIVE | ||||||||
| Address2: | 1ST FLOOR CLINIC | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7736653211 | ||||||||
| FaxNumber: | 7736653498 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | STEINER | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR, MEDICAL STAFF OFFICE | ||||||||
| AuthorizedOfficialTelephone: | 7736653308 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 1632127 | 01 | IL | BCBS PROVIDER # | OTHER |