Provider Demographics
NPI:1497830376
Name:CHICAGO DEPARTMENT OF PUBLIC HEALTH
Entity Type:Organization
Organization Name:CHICAGO DEPARTMENT OF PUBLIC HEALTH
Other - Org Name:WEST TOWN N.H.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VITTUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-744-7448
Mailing Address - Street 1:3519 W WRIGHTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1248
Mailing Address - Country:US
Mailing Address - Phone:773-395-9314
Mailing Address - Fax:
Practice Address - Street 1:2418 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2940
Practice Address - Country:US
Practice Address - Phone:312-744-7448
Practice Address - Fax:312-744-5516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare