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General NPI Number Information
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NPI Number | 1093097040
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Entity Type | Organization
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Legal Business Name | NORTHWESTERN MEMORIAL PHYSICIANS GROUP
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Dates
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Enumeration Date | 09/15/2011
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Last Update Date | 09/15/2011
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Provider Practice Location Address
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Address Line | 1460 N HALSTED ST SUITE 502
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City | CHICAGO
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State | IL
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Zip | 60642-2605
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Country | US
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Telephone | 312-926-7028
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Fax |
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Provider Business Mailing Address
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Address Line | 1460 N HALSTED ST SUITE 502
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City | CHICAGO
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State | IL
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Zip | 60642-2605
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT OF OPERATIONS
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Name | MRS. CYNTHIA KNOLL
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Credential |
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Telephone | 312-926-6147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | 036095919
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License Number State | IL
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