Provider Demographics
NPI:1053612275
Name:SAINT JOSEPH HOSPITAL
Entity type:Organization
Organization Name:SAINT JOSEPH HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALWAKKAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-715-1934
Mailing Address - Street 1:2828 N CAMBRIDGE AVE APT 406
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6051
Mailing Address - Country:US
Mailing Address - Phone:773-715-1934
Mailing Address - Fax:
Practice Address - Street 1:2900 N. LAKESHORE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:773-665-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125058676282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital