Healthcare Provider Details

I. General information

NPI: 1215156450
Provider Name (Legal Business Name): NORTHWEST SUBURBAN URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S. MILUAKEE AVE.
LAKE VILLA IL
60046
US

IV. Provider business mailing address

201 S. MILUAKEE AVE.
LAKE VILLA IL
60046
US

V. Phone/Fax

Practice location:
  • Phone: 847-356-9016
  • Fax:
Mailing address:
  • Phone: 847-356-9016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberIL-01417-01
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2471N0900X
TaxonomyNuclear Medicine Technology Radiologic Technologist
License NumberIL-01417-01
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License NumberIL-01417-01
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code242T00000X
TaxonomyPerfusionist
License NumberIL-01417-01
License Number StateIL

VIII. Authorized Official

Name: DR. ROBERT MCMILLER
Title or Position: RADIOLOGIST
Credential: M.D.
Phone: 847-356-9016