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General NPI Number Information
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NPI Number | 1396973350
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Entity Type | Organization
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Legal Business Name | NORTHWESTERN MCGAW CENTER FOR GRADUATE MEDICAL EDUCATION
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 645 N MICHIGAN AVE SUITE 1058 A
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City | CHICAGO
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State | IL
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Zip | 60611-2826
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Country | US
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Telephone | 312-926-9512
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Fax |
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Provider Business Mailing Address
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Address Line | 259 E ERIE ST SUITE 100
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City | CHICAGO
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State | IL
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Zip | 60611-2930
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Country | US
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Telephone | 312-926-9512
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Fax |
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Authorized Official
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Title or Position | RESIDENT PHYSICIAN
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Name | DR. NICHOLAS ALEXANDER BORM
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Credential | M.D.
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Telephone | 404-803-3326
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State | IL
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