MEDICARE: NORTHWESTERN PERINATAL ASSOCIATES, S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VH0002X	Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician	036058725	IL
2	207VG0400X	Gynecology Physician	036-058725	IL
3	207VX0000X	Obstetrics Physician	036-058725	IL
4	207VM0101X	Maternal & Fetal Medicine Physician	036-058725	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457565426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWESTERN PERINATAL ASSOCIATES, S.C.

Provider Business Mailing Address
First Line	:	680 N LAKE SHORE DRIVE
Second Line	:	SUITE 1428
City	:	CHICAGO
State	:	IL
Zip	:	60611-8700
Country	:	US
Telephone Number	:	312-981-4350
Fax Number	:	312-981-4363

Provider Business Practice Location Address
First Line	:	680 N LAKE SHORE DRIVE
Second Line	:	SUITE 1428
City	:	CHICAGO
State	:	IL
Zip	:	60611-8700
Country	:	US
Telephone Number	:	312-981-4350
Fax Number	:	312-981-4363

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MS. JUDI L GRETZ
Credential	:	RN
Telephone Number	:	312-981-4350

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	04/27/2010

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Directions to “NORTHWESTERN PERINATAL ASSOCIATES, S.C. ” Practice Location

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