Healthcare Provider Details

I. General information

NPI: 1225344906
Provider Name (Legal Business Name): NORTHWEST PRIMARY CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2214 HUNTINGTON DR N
ALGONQUIN IL
60102-4419
US

IV. Provider business mailing address

2214 HUNTINGTON DR N
ALGONQUIN IL
60102-4419
US

V. Phone/Fax

Practice location:
  • Phone: 847-458-4500
  • Fax: 847-458-4503
Mailing address:
  • Phone: 847-458-4500
  • Fax: 847-458-4503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierIL6276
Identifier TypeOTHER
Identifier State
Identifier IssuerPTAN
# 2
IdentifierIL6276
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerPTAN
# 3
IdentifierIL6278
Identifier TypeOTHER
Identifier State
Identifier IssuerPTAN
# 4
IdentifierIL6277
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerPTAN
# 5
IdentifierIL6277
Identifier TypeOTHER
Identifier State
Identifier IssuerPTAN
# 6
IdentifierIL6278
Identifier TypeOTHER
Identifier StateIL
Identifier IssuerPTAN

VIII. Authorized Official

Name: DR. DEVANG N DHARIA
Title or Position: M.D.
Credential: M.D.
Phone: 847-458-4500