Provider Demographics
NPI:1740567312
Name:JACKSON PARK HOSPITAL
Entity Type:Organization
Organization Name:JACKSON PARK HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUKSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZNEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-947-7500
Mailing Address - Street 1:1625 E 75TH ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-3603
Mailing Address - Country:US
Mailing Address - Phone:773-947-7500
Mailing Address - Fax:
Practice Address - Street 1:1625 E 75TH ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3603
Practice Address - Country:US
Practice Address - Phone:773-947-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-10
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.060628282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital