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General NPI Number Information
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NPI Number | 1255414926
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Entity Type | Organization
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Legal Business Name | NORTHWEST PULMONARY ASSOCIATES, S.C.
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 10/27/2022
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Provider Practice Location Address
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Address Line | 7447 W TALCOTT AVE SUITE 542
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City | CHICAGO
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State | IL
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Zip | 60631-3745
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Country | US
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Telephone | 773-631-2180
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Fax | 773-631-5947
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Provider Business Mailing Address
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Address Line | 7447 W TALCOTT AVE SUITE 542
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City | CHICAGO
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State | IL
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Zip | 60631-3745
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Country | US
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Telephone | 773-631-2180
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Fax | 773-631-5947
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Authorized Official
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Title or Position | PRESIDENT
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Name | LARRY M JANKELOWITZ
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Credential | MD
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Telephone | 773-631-2180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 042007411
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License Number State | IL
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