Provider Demographics
NPI:1205091725
Name:LOYOLA UNIVERSITY MEDICAL CENTTER
Entity type:Organization
Organization Name:LOYOLA UNIVERSITY MEDICAL CENTTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./PGY-4
Authorized Official - Prefix:DR
Authorized Official - First Name:SARKIS
Authorized Official - Middle Name:GIBRAN
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-442-9572
Mailing Address - Street 1:7716 W ODGEN AVE APT 3R
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:IL
Mailing Address - Zip Code:60534-1287
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LOYOLA UNIVERSITY MEDICAL CENTER, DEPARTMENT OF NEUROLO
Practice Address - Street 2:MAGUIRE CENTER - SUITE 2700, 2160 SOUTH FIRST AVENUE
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-4702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125050314282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital