MEDICARE: NORTHWEST SUBURBAN MEDICAL ASSOCIATES, SC.

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	174400000X	Specialist

General Provider Information

NPI Number	:	1548206451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST SUBURBAN MEDICAL ASSOCIATES, SC.

Provider Business Mailing Address
First Line	:	880 W CENTRAL RD
Second Line	:	SUITE 8100
City	:	ARLINGTON HTS
State	:	IL
Zip	:	60005-2355
Country	:	US
Telephone Number	:	847-255-5030
Fax Number	:	847-255-0156

Provider Business Practice Location Address
First Line	:	880 W CENTRAL RD
Second Line	:	SUITE 8100
City	:	ARLINGTON HTS
State	:	IL
Zip	:	60005-2355
Country	:	US
Telephone Number	:	847-255-5030
Fax Number	:	847-255-0156

Authorized Official
Title or Position	:	BUSINESS MANGER SR.
Name	:	MRS. DONNA L LEMKE
Credential	:	BUSINESS OFFICE
Telephone Number	:	847-255-7226

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	10/06/2021

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