Basic Information
| Provider Information | |||||||||
| NPI: | 1356631824 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWESTERN MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 E 8TH ST | ||||||||
| Address2: | APT 1804 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606052168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082135346 | ||||||||
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| Practice Location | |||||||||
| Address1: | 675 N SAINT CLAIR ST | ||||||||
| Address2: | SUITE 18-250 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606115975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126959871 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2011 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | SPORN | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROGRAM DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3129088163 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | IL | Y | Hospitals | General Acute Care Hospital |
No ID Information.