Healthcare Provider Details

I. General information

NPI: 1003938762
Provider Name (Legal Business Name): NORMA B WESTERVELT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

966 W 21ST ST ALIVIO MEDICAL CENTER
CHICAGO IL
60608-4511
US

IV. Provider business mailing address

1424 MARENGO AVE
FOREST PARK IL
60130-2622
US

V. Phone/Fax

Practice location:
  • Phone: 773-254-1400
  • Fax:
Mailing address:
  • Phone: 708-488-9434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36114888
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: