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Organization
NORTHWESTERN MEMORIAL PHYSICIANS GROUP
Active
Organization
NORTHWESTERN MEMORIAL PHYSICIANS GROUP
Active
Parent organization
NORTHWESTERN MEDICAL FACULTY FOUNDATION (D/B/A NORTHWESTERN MEDICAL GR
Other names
NMPG
Organization subpart
Yes
Provider details
NPI number
Legal business name
NORTHWESTERN MEDICAL FACULTY FOUNDATION (D/B/A NORTHWESTERN MEDICAL GR
Authorized official
JUSTIN JOHNSON (VP FINANCE)
(312) 926-1599
Entity
Organization
Contact information
Practice address
680 N LAKE SHORE DR, SUITE 818, CHICAGO, IL 60611-4546
(312) 926-6146
Mailing address
680 N LAKE SHORE DR, SUITE 818, CHICAGO, IL 60611-4546
(312) 926-6146
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
111N00000X
Chiropractor
—
—
133N00000X
Nutritionist
—
—
207N00000X
Dermatology Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RG0100X
Gastroenterology Physician
036-061908
IL
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
036070574
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IL5771
LAKE FOREST MEDICARE
IL
Enumeration date
05/17/2006
Last updated
09/30/2013
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