Provider Demographics
NPI:1215628169
Name:LOYOLA UNIVERSITY MEDICAL CENTER
Entity type:Organization
Organization Name:LOYOLA UNIVERSITY MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-216-0464
Mailing Address - Street 1:17901 S. LA GRANGE ROAD
Mailing Address - Street 2:RM 1112
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-7226
Mailing Address - Country:US
Mailing Address - Phone:708-327-8200
Mailing Address - Fax:708-327-8297
Practice Address - Street 1:17901 S. LA GRANGE ROAD
Practice Address - Street 2:RM 1112
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-7226
Practice Address - Country:US
Practice Address - Phone:708-327-8200
Practice Address - Fax:708-327-8297
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOYOLA UNIVERSITY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-19
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy