# NORTHWEST MEDICAL AND URGENT CARE CENTER AT SOUTH SHORE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235625138
- **Authorized official:** MRS. TAMARA PETROV (OFFICE MANAGER)
- **Authorized official phone:** (773) 353-5047

## Contact information

- **Practice address:** 1952 E 73RD ST, CHICAGO, IL 60649-2902
- **Practice address phone:** (773) 493-5600
- **Mailing address:** 5352 N LINCOLN AVE, CHICAGO, IL 60625-2316
- **Mailing address phone:** (773) 353-5047
- **Mailing address fax:** (773) 353-2406

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 07/03/2018
- **Last updated:** 07/03/2018