Organization
NORTHWESTERN MEMORIAL PHYSICIANS GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CYNTHIA KNOLL (VICE PRESIDENT OF OPERATIONS)
(312) 926-6147
Entity
Organization
Contact information
Practice address
1460 N HALSTED ST, SUITE 502, CHICAGO, IL 60642-2605
(312) 926-7028
Mailing address
1460 N HALSTED ST, SUITE 502, CHICAGO, IL 60642-2605
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
036095919
IL
Other
Enumeration date
09/15/2011
Last updated
09/15/2011
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