| West Loop University Medicine, Ltd. | |
|
1725 W Harrison St Suite 774 Chicago IL 60612-3841 | |
| (312) 942-6013 | |
| (312) 829-2024 |
| Full Name | West Loop University Medicine, Ltd. |
|---|---|
| Speciality | Internal Medicine |
| Location | 1725 W Harrison St, Chicago, Illinois |
| Authorized Official Name and Position | Joseph J Hennessy (PRESIDENT) |
| Authorized Official Contact | 6307180200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| West Loop University Medicine, Ltd. 1730 Park St Suite 101 Naperville IL 60563-2688 Ph: (630) 718-0200 | West Loop University Medicine, Ltd. 1725 W Harrison St Suite 774 Chicago IL 60612-3841 Ph: (312) 942-6013 |
| NPI Number | 1730154030 |
|---|---|
| Provider Enumeration Date | 02/21/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4688653652 |
|---|---|
| Medicare Enrollment ID | O20040714001454 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730154030 | NPI | - | NPPES |
| 0160378251 | Other | IL | BLUE CROSS / BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Patricia M Schultz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285609149 PECOS PAC ID: 7517946205 Enrollment ID: I20040716000074 |
| Provider Name | Frank C Kelly |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679548622 PECOS PAC ID: 9133170046 Enrollment ID: I20050208001064 |
| Provider Name | Sean S Ryan |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1841584992 PECOS PAC ID: 3779755145 Enrollment ID: I20111006000404 |
| Provider Name | Amanda L Cuca |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033462643 PECOS PAC ID: 8628221215 Enrollment ID: I20130110000021 |
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