Healthcare Provider Details

I. General information

NPI: 1700948742
Provider Name (Legal Business Name): GREATER NORTHWEST MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 W RAND RD
ARLINGTON HEIGHTS IL
60004-2315
US

IV. Provider business mailing address

1051 W RAND RD
ARLINGTON HEIGHTS IL
60004-2315
US

V. Phone/Fax

Practice location:
  • Phone: 847-342-8220
  • Fax:
Mailing address:
  • Phone: 847-342-8220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. LINDA AEMISEGGER
Title or Position: BUSINESS MANAGER
Credential:
Phone: 847-459-7860