NPIMap

Organization Active NPI

Advocate Lutheran General Hospital

  • Primary Care Clinic/Center
  • Park Ridge, IL
National Provider Identifier
1497982037
Registry record updated Jun 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
125.056297 Issued in IL
Legal business name
ADVOCATE LUTHERAN GENERAL HOSPITAL
Practice address
1775 Dempster St
Park Ridge, IL 60068-1143
Phone
(847) 723-7979
NPI assigned
Jun 22, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mariola Mjaltaj, M.D
Title
Resident
Phone
(773) 704-6643

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 125.056297 IL Primary

Addresses

Primary practice location

1775 Dempster St
Park Ridge, IL 60068-1143

Mailing address

2127 N 72ND CT
Elmwood Park, IL 60707-3104
Phone (773) 704-6643

National Provider Directory

National Provider Directory
Tax ID family
Community Care Services456 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 11

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245628800000",
    "number": "1497982037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2127 N 72ND CT",
            "city": "ELMWOOD PARK",
            "state": "IL",
            "postal_code": "607073104",
            "telephone_number": "773-704-6643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1775 DEMPSTER ST",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681143",
            "telephone_number": "847-723-7979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVOCATE LUTHERAN GENERAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-22",
        "last_updated": "2009-06-22",
        "status": "A",
        "authorized_official_last_name": "MJALTAJ",
        "authorized_official_first_name": "MARIOLA",
        "authorized_official_title_or_position": "RESIDENT",
        "authorized_official_telephone_number": "773-704-6643",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IL",
            "license": "125.056297",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Ridge, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.