Provider Demographics
NPI:1063963635
Name:ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO
Entity type:Organization
Organization Name:ANN & ROBERT H. LURIE CHILDREN'S HOSPITAL OF CHICAGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINCIAL OFFICE COORDINATOR- REHAB
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:GUSTAVO
Authorized Official - Last Name:SOLIS LARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-227-3064
Mailing Address - Street 1:225 E CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-0480
Mailing Address - Fax:312-227-9478
Practice Address - Street 1:225 E CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:312-227-0480
Practice Address - Fax:312-227-9478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147.001607231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty