Healthcare Provider Details

I. General information

NPI: 1427741909
Provider Name (Legal Business Name): NORTHWESTERN MEDICAL FACULTY FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 SHERMAN AVE STE 100
EVANSTON IL
60201-3711
US

IV. Provider business mailing address

1630 SHERMAN AVE STE 100
EVANSTON IL
60201-3711
US

V. Phone/Fax

Practice location:
  • Phone: 224-271-4860
  • Fax: 224-271-4870
Mailing address:
  • Phone: 224-271-4860
  • Fax: 224-271-4870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

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