Provider Demographics
NPI:1487990156
Name:UNIVERSITY OF CHICAGO PHYSICIANS GROUP
Entity type:Organization
Organization Name:UNIVERSITY OF CHICAGO PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF HR OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAATHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-795-3456
Mailing Address - Street 1:11751 S EWING AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-7300
Mailing Address - Country:US
Mailing Address - Phone:773-646-9864
Mailing Address - Fax:
Practice Address - Street 1:180 HARVESTER DR
Practice Address - Street 2:SUITE 110
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-7594
Practice Address - Country:US
Practice Address - Phone:773-795-3456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009409261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty