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General NPI Number Information
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NPI Number | 1336395342
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Entity Type | Organization
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Legal Business Name | NORTHWESTERN DEPARTMENT OF NEUROSURGERY
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Dates
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Enumeration Date | 08/09/2008
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Last Update Date | 08/09/2008
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Provider Practice Location Address
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Address Line | 676 N SAINT CLAIR ST SUITE 2210
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City | CHICAGO
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State | IL
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Zip | 60611-2927
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Country | US
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Telephone | 312-922-0898
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Fax |
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Provider Business Mailing Address
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Address Line | 676 N SAINT CLAIR ST SUITE 2210
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City | CHICAGO
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State | IL
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Zip | 60611-2927
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Country | US
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Telephone | 312-922-0898
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Fax |
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Authorized Official
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Title or Position | CHIEF RESIDENT
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Name | DR. DAVID JEFFERY MOLLER
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Credential | M.D.
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Telephone | 312-922-0898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 036.121196
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License Number State | IL
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