# MOUNT SINAI COMMUNITY FOUNDATION DBA SINAI MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MOUNT SINAI COMMUNITY FOUNDATION DBA SINAI MEDICAL GROUP
- **Other names:** SMG OB on Central
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1104471622
- **Legal business name:** MOUNT SINAI COMMUNITY FOUNDATION DBA SINAI MEDICAL GROUP
- **Authorized official:** DEBORAH CAPUTO (CREDENTIALING MANAGER)
- **Authorized official phone:** (773) 257-2905

## Contact information

- **Practice address:** 645 S CENTRAL AVE FL 6, CHICAGO, IL 60644-5059
- **Practice address phone:** (773) 854-5328
- **Practice address fax:** (773) 854-5587
- **Mailing address:** 1501 S CALIFORNIA AVE NR 7-130, CHICAGO, IL 60608
- **Mailing address phone:** (773) 257-2905
- **Mailing address fax:** (773) 257-1788

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207VX0000X | Obstetrics Physician | — | NULL | Yes |
| 207VX0000X | Obstetrics Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/02/2019
- **Last updated:** 08/02/2019