MEDICARE: NORTHWEST COMMUNITY HEALTH SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician
3	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1205107588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST COMMUNITY HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	199 W RAND RD
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-1129
Country	:	US
Telephone Number	:	847-618-5450
Fax Number	:	847-618-5459

Provider Business Practice Location Address
First Line	:	199 W RAND RD
Second Line	:
City	:	MOUNT PROSPECT
State	:	IL
Zip	:	60056-1129
Country	:	US
Telephone Number	:	847-618-5450
Fax Number	:	847-618-5459

Authorized Official
Title or Position	:	EVP CLINICS & REGIONAL SERVICES
Name	:	MICHAEL C HARTKE
Credential	:
Telephone Number	:	847-618-5004

Provider Enumeration Date	:	01/19/2012
Last Update Date	:	03/16/2022

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