Provider Demographics
NPI:1265407209
Name:HENNESSY, JOSEPH J (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:HENNESSY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:676 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 3120
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2883
Mailing Address - Country:US
Mailing Address - Phone:312-780-2301
Mailing Address - Fax:312-780-2304
Practice Address - Street 1:676 N MICHIGAN AVE
Practice Address - Street 2:SUITE 3120
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2883
Practice Address - Country:US
Practice Address - Phone:312-780-2301
Practice Address - Fax:312-780-2304
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2010-08-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036082176207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036082176Medicaid
ILE83651Medicare UPIN