Provider Demographics
NPI:1780815407
Name:ADVOCATE ILLINOIS MASONIC
Entity Type:Organization
Organization Name:ADVOCATE ILLINOIS MASONIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOUSE STAFF COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-296-5944
Mailing Address - Street 1:856 W NELSON ST APT 1905
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-9204
Mailing Address - Country:US
Mailing Address - Phone:773-313-5281
Mailing Address - Fax:
Practice Address - Street 1:856 W NELSON ST APT 1905
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-9204
Practice Address - Country:US
Practice Address - Phone:773-313-5281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125057009282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital