Provider Demographics
NPI:1750570743
Name:GREATER CHICAGO UROLOGY
Entity type:Organization
Organization Name:GREATER CHICAGO UROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALENTINA
Authorized Official - Middle Name:ALHAMBRA
Authorized Official - Last Name:CONSTANTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-328-8884
Mailing Address - Street 1:800 AUSTIN ST
Mailing Address - Street 2:SUITE 569 E
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3439
Mailing Address - Country:US
Mailing Address - Phone:847-328-8884
Mailing Address - Fax:847-328-9129
Practice Address - Street 1:800 AUSTIN ST
Practice Address - Street 2:SUITE 569 E
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3439
Practice Address - Country:US
Practice Address - Phone:847-328-8884
Practice Address - Fax:847-328-9129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH16652Medicare UPIN