# MD2 CHICAGO

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

## Provider details

- **NPI number:** 1568742542
- **Authorized official:** DR. JOSEPH J HENNESSY MD (PRESIDENT)
- **Authorized official phone:** (312) 780-2301

## Contact information

- **Practice address:** 676 N MICHIGAN AVE, SUITE 3120, CHICAGO, IL 60611-2883
- **Practice address phone:** (312) 780-2301
- **Practice address fax:** (312) 780-2304
- **Mailing address:** 676 N MICHIGAN AVE, SUITE 3120, CHICAGO, IL 60611-2883
- **Mailing address phone:** (312) 780-2301
- **Mailing address fax:** (312) 780-2304

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | 036082176 | IL | Yes |

## Other

- **Enumeration date:** 08/23/2011
- **Last updated:** 08/23/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 036082176 | — | IL |