Healthcare Provider Details

I. General information

NPI: 1912321621
Provider Name (Legal Business Name): NORTHWESTERN MEDICAL FACULTY FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2014
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 N MICHIGAN AVE SUITE#700
CHICAGO IL
60611-2615
US

IV. Provider business mailing address

680 N LAKE SHORE DR SUITE# 1000
CHICAGO IL
60611-4546
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-5928
  • Fax: 312-337-3601
Mailing address:
  • Phone: 312-695-9797
  • Fax: 312-695-6680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. RUSSELL B. COX
Title or Position: DELEGATED OFFICIAL
Credential:
Phone: 312-695-9797