Organization
EVANSTON NORTHWESTERN HEALTHCARE MEDICAL GROUP
Active
Organization
EVANSTON NORTHWESTERN HEALTHCARE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VICTORIA L WELTER (DIRECTOR HMO ADMINISTRATION)
(815) 490-6752
Entity
Organization
Contact information
Practice address
630 E JEFFERSON ST, ROCKFORD, IL 61107-4026
(815) 967-7399
Mailing address
630 E JEFFERSON ST, ROCKFORD, IL 61107-4026
(815) 967-7399
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Enumeration date
11/17/2006
Last updated
08/22/2020
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