Provider Demographics
NPI:1114243425
Name:CHICAGO DEPARTMENT OF PUBLIC HEALTH
Entity Type:Organization
Organization Name:CHICAGO DEPARTMENT OF PUBLIC HEALTH
Other - Org Name:CDPH
Other - Org Type:Other Name
Authorized Official - Title/Position:FIRST DEPUTY COMMISSIONER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:W
Authorized Official - Last Name:BEAUDET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-747-9889
Mailing Address - Street 1:333 S STATE ST
Mailing Address - Street 2:ROOM 200 - REVENUE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-3900
Mailing Address - Country:US
Mailing Address - Phone:312-747-9545
Mailing Address - Fax:312-746-7603
Practice Address - Street 1:845 W WILSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5704
Practice Address - Country:US
Practice Address - Phone:312-744-1938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF CHICAGO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14D0043704Medicaid