1770992448 NPI number — NORTHWESTERN MEDICAL FACULTY FOUNDATION

Table of content: (NPI 1770992448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770992448 NPI number — NORTHWESTERN MEDICAL FACULTY FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWESTERN MEDICAL FACULTY FOUNDATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NORTHWESTERN MEDICAL GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770992448
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
680 N LAKE SHORE DR
Provider Second Line Business Mailing Address:
SUITE# 1000
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60611-8709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-695-9797
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1475 E BELVIDERE RD
Provider Second Line Business Practice Location Address:
SUITE# 1297
Provider Business Practice Location Address City Name:
GRAYSLAKE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60030-2012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-295-0001
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/07/2014

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
JUSTIN
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
VP,CFO
Authorized Official Telephone Number:
312-926-1599

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WC0802X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WV0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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