Provider Demographics
NPI:1689776783
Name:ADVOCATE LUTHERAN GENERAL HOSPITAL
Entity Type:Organization
Organization Name:ADVOCATE LUTHERAN GENERAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR GYNECOLOGIC ONCOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:DOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-723-7758
Mailing Address - Street 1:1700 LUTHER LN
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1270
Mailing Address - Country:US
Mailing Address - Phone:847-723-7758
Mailing Address - Fax:847-723-8521
Practice Address - Street 1:1700 LUTHER LN
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1270
Practice Address - Country:US
Practice Address - Phone:847-723-7758
Practice Address - Fax:847-723-8521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE18973Medicare UPIN
ILL69274Medicare ID - Type Unspecified