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General NPI Number Information
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NPI Number | 1194775221
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Entity Type | Organization
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Legal Business Name | NORTHWEST INFECTIOUS DISEASE CONSULTANTS, S.C.
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 12/08/2010
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Provider Practice Location Address
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Address Line | 7900 N MILWAUKEE AVE SUITE 231
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City | NILES
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State | IL
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Zip | 60714-3159
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Country | US
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Telephone | 847-663-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 7900 N MILWAUKEE AVE SUITE 231
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City | NILES
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State | IL
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Zip | 60714-3159
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Country | US
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Telephone | 847-663-9400
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT J. CITRONBERG
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Credential | M.D.
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Telephone | 847-663-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 042617264
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License Number State | IL
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