Organization
MD2 CHICAGO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH J HENNESSY MD (PRESIDENT)
(312) 780-2301
Entity
Organization
Contact information
Practice address
676 N MICHIGAN AVE, SUITE 3120, CHICAGO, IL 60611-2883
(312) 780-2301
(312) 780-2304
Mailing address
676 N MICHIGAN AVE, SUITE 3120, CHICAGO, IL 60611-2883
(312) 780-2301
(312) 780-2304
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
036082176
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036082176
—
IL
Enumeration date
08/23/2011
Last updated
08/23/2011
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