Healthcare Provider Details

I. General information

NPI: 1205763885
Provider Name (Legal Business Name): NORTHWESTERN MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N STATE ST
CHICAGO IL
60654-3820
US

IV. Provider business mailing address

1215 N WOLCOTT AVE
CHICAGO IL
60622-3127
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-1500
  • Fax:
Mailing address:
  • Phone: 312-694-9393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CY WHITLER
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 270-931-0162