Provider Demographics
NPI:1508198383
Name:SAINT JOSEPH HOSPITAL
Entity Type:Organization
Organization Name:SAINT JOSEPH HOSPITAL
Other - Org Name:NEUROSURGICAL SERVICES - DR. ROGER LICHTENBAUM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PHYS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-665-3000
Mailing Address - Street 1:1431 N WESTERN AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1797
Mailing Address - Country:US
Mailing Address - Phone:312-332-2226
Mailing Address - Fax:773-276-1197
Practice Address - Street 1:2800 N SHERIDAN RD
Practice Address - Street 2:SUITE 304
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6156
Practice Address - Country:US
Practice Address - Phone:312-332-2226
Practice Address - Fax:773-276-1197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty