=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093568073
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOWER GLOBAL GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2024
-----------------------------------------------------
Last Update Date | 04/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6201 W HOWARD ST STE 211A
-----------------------------------------------------
City | NILES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60714-3435
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-985-0486
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6419 W TOUHY AVE APT 4A
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60646-1040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-985-0486
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | DWAYNE A HIGHTOWER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-899-6657
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------