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General NPI Number Information
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NPI Number | 1235148891
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Entity Type | Organization
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Legal Business Name | LOYOLA UNIVERSITY PHYSICIAN FOUNDATION
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 09/02/2008
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Provider Practice Location Address
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Address Line | 2160 S 1ST AVE
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 800-424-6307
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Fax |
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Provider Business Mailing Address
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Address Line | 2 WESTBROOK CORPORATE CTR S#600
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City | WESTCHESTER
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State | IL
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Zip | 60154-5702
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Country | US
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Telephone | 800-424-6307
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT AND CFO
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Name | MR. PETER GOUWS
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Credential |
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Telephone | 708-216-3981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State | IL
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