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General NPI Number Information
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NPI Number | 1356631824
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Entity Type | Organization
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Legal Business Name | NORTHWESTERN MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 04/18/2011
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 675 N SAINT CLAIR ST SUITE 18-250
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City | CHICAGO
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State | IL
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Zip | 60611-5975
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Country | US
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Telephone | 312-695-9871
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Fax |
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Provider Business Mailing Address
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Address Line | 41 E 8TH ST APT 1804
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City | CHICAGO
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State | IL
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Zip | 60605-2168
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Country | US
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Telephone | 608-213-5346
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | PETER SPORN
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Credential |
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Telephone | 312-908-8163
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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 |
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License Number State | IL
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