Provider Demographics
NPI:1316329162
Name:CHICAGO MEDICAL SCHOOL
Entity type:Organization
Organization Name:CHICAGO MEDICAL SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRY DEPARTMENT CHAIR
Authorized Official - Prefix:MS
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GARFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-208-9090
Mailing Address - Street 1:3333 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-3037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3333 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3037
Practice Address - Country:US
Practice Address - Phone:734-286-4594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-28
Last Update Date:2015-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125067684273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL125067684OtherIL MEDICAL NUMBER