Basic Information
Provider Information
NPI: 1619364460
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JOSEPH
FirstName: SILAS
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 180 HARVESTER DR
Address2: SUITE 110
City: BURR RIDGE
State: IL
PostalCode: 605277594
CountryCode: US
TelephoneNumber: 7737021150
FaxNumber:  
Practice Location
Address1: 5841 S MARYLAND AVE
Address2: MC 4028
City: CHICAGO
State: IL
PostalCode: 606371447
CountryCode: US
TelephoneNumber: 7737026842
FaxNumber: 7738340063
Other Information
ProviderEnumerationDate: 04/20/2015
LastUpdateDate: 05/04/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X125066931ILY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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