# HUMBOLDT PARK HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PHYSICIAN SPECIALTY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609045863
- **Authorized official:** DOROTHY CHERYL ERINS (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (269) 244-5256

## Contact information

- **Practice address:** 1044 N FRANCISCO AVE, CHICAGO, IL 60622-2743
- **Practice address phone:** (773) 292-8200
- **Practice address fax:** (773) 278-3899
- **Mailing address:** 1799 MOMENTUM PL, LOCK BOX 231799, CHICAGO, IL 60689-5317
- **Mailing address phone:** (773) 292-8200
- **Mailing address fax:** (773) 278-3899

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 000007296 | IL | — |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/21/2008
- **Last updated:** 01/27/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 01618185 | BCBS | IL |
| 01 | — | 945301 | GROUP | IL |