=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003938762
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NORMA B WESTERVELT M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2007
-----------------------------------------------------
Last Update Date | 09/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 966 W 21ST ST ALIVIO MEDICAL CENTER
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60608-4511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-254-1400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1424 MARENGO AVE
-----------------------------------------------------
City | FOREST PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60130-2622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-488-9434
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 36114888
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------