Organization
NORTHWEST SUBURBAN UROLOGY ASSOCIATES SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JUDITH JEROME (PRACTICE MANAGER)
(847) 871-4772
Entity
Organization
Contact information
Practice address
800 BIESTERFIELD RD, SUITE 303, ELK GROVE VILLAGE, IL 60007-7312
(847) 593-0404
(847) 593-1509
Mailing address
800 BIESTERFIELD RD, SUITE 303, ELK GROVE VILLAGE, IL 60007-7312
(847) 593-0404
(847) 593-1509
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
946350
PTAN
IL
Enumeration date
11/14/2006
Last updated
12/29/2014
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