Organization
CHICAGO STATE UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA YOUNG DNP (CHAIRPERSON)
(773) 995-2000
Entity
Organization
Contact information
Practice address
11228 S EMERALD AVE, CHICAGO, IL 60628-4707
(773) 821-7155
Mailing address
11228 S EMERALD AVE, CHICAGO, IL 60628-4707
(773) 821-7155
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
209015881
IL
Other
Enumeration date
05/01/2017
Last updated
05/01/2017
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