# ILLINOIS MASONIC HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083040786
- **Authorized official:** LISE HAUSER CNM (SUPERVISOR OF CNM SERVICES)
- **Authorized official phone:** (773) 296-3098

## Contact information

- **Practice address:** 3048 N WILTON AVE, 3RD FLOOR, CHICAGO, IL 60657-6710
- **Practice address phone:** (773) 296-3098
- **Mailing address:** 3048 N WILTON AVE, 3RD FLOOR, CHICAGO, IL 60657-6710

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282NW0100X | Women's Hospital | 209.010657 | IL | Yes |

## Other

- **Enumeration date:** 09/25/2013
- **Last updated:** 09/25/2013