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NPI Code Detail

MEDICARE: NORTHWEST MEDICAL ASSOCIATES OF CHICAGO LLC

MEDICARE: NORTHWEST MEDICAL ASSOCIATES OF CHICAGO LLC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18417110959OTHERILEIN NUMBER

General Provider Information

NPI Number : 1932218708
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHWEST MEDICAL ASSOCIATES OF CHICAGO LLC
Provider Business Mailing Address
First Line : 2875 W 19TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60623-3501
Country : US
Telephone Number : 773-262-4588
Fax Number : 773-761-5742
Provider Business Practice Location Address
First Line : 2875 W 19TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60623-3501
Country : US
Telephone Number : 773-262-4588
Fax Number : 773-761-5742
Authorized Official
Title or Position : PRESIDENT/CEO
Name : MR. OGBONNAYA ANEZIOKORO
Credential : MD
Telephone Number : 773-262-4588
Provider Enumeration Date : 08/29/2006
Last Update Date : 08/22/2020

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Directions to “NORTHWEST MEDICAL ASSOCIATES OF CHICAGO LLC ” Practice Location

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