Basic Information
| Provider Information | |||||||||
| NPI: | 1972787877 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REHABILITATION INSTITUTE OF CHICAGO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 345 E SUPERIOR ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606112654 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1030 N CLARK ST | ||||||||
| Address2: | STES 320 & 647 (CHRONIC PAIN CARE CTR) | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606105467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3122387800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2007 | ||||||||
| LastUpdateDate: | 12/27/2007 | ||||||||
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| AuthorizedOfficialLastName: | CASE | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE VICE PRESIDENT, CFO | ||||||||
| AuthorizedOfficialTelephone: | 3122382036 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283X00000X | 1779599 | IL | Y | Hospitals | Rehabilitation Hospital |
No ID Information.