Provider Demographics
NPI:1518088319
Name:LURIE CHILDREN'S MEDICAL GROUP
Entity Type:Organization
Organization Name:LURIE CHILDREN'S MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:NOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-227-7200
Mailing Address - Street 1:225 E CHICAGO AVE
Mailing Address - Street 2:#64
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2991
Mailing Address - Country:US
Mailing Address - Phone:312-227-7200
Mailing Address - Fax:312-227-9150
Practice Address - Street 1:467 W DEMING PL
Practice Address - Street 2:SUITE 900
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1881
Practice Address - Country:US
Practice Address - Phone:773-327-2950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty