Healthcare Provider Details

I. General information

NPI: 1124733019
Provider Name (Legal Business Name): NORTHWESTERN MEDICAL FACULTY FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 MAPLE AVE STE 200
EVANSTON IL
60201-3134
US

IV. Provider business mailing address

DEPT 5777
CAROL STREAM IL
60122
US

V. Phone/Fax

Practice location:
  • Phone: 847-535-8500
  • Fax: 847-535-6949
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SABINA STRZEMINSKA
Title or Position: DIRECTOR
Credential:
Phone: 312-695-0646