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General NPI Number Information
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NPI Number | 1407381197
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Entity Type | Organization
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Legal Business Name | NORTHWESTERN MEMORIAL HEALTHCARE
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Dates
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Enumeration Date | 05/01/2017
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Last Update Date | 05/01/2017
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Provider Practice Location Address
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Address Line | 675 N SAINT CLAIR ST SUITE 21-100
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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 | 312-695-1192
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Fax | 312-695-1106
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Provider Business Mailing Address
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Address Line | 675 N SAINT CLAIR ST SUITE 21-100
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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 | 312-695-1192
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Fax | 312-695-1106
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Authorized Official
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Title or Position | MANAGED CARE SPECIALIST
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Name | LATIFAH BOYD
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Credential | MPH
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Telephone | 312-926-6354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0200X
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Taxonomy Name | Oncology Clinic/Center
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License Number | 164005630
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License Number State | IL
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