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General NPI Number Information
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NPI Number | 1437315017
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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 | 08/01/2008
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 446 E ONTARIO ST STE 7-200
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City | CHICAGO
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State | IL
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Zip | 60611-4418
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Country | US
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Telephone | 312-926-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 4048 W COLUMBIA AVE
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-3502
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Country | US
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Telephone | 847-679-1284
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Fax |
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Authorized Official
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Title or Position | RESIDENT
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Name | DR. SAJOY PURATHUMURIYIL VARGHESE
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Credential | M.D.
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Telephone | 847-413-8367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 125053871
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License Number State | IL
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