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Organization

LOYOLA UNIVERSITY PHYSICIAN FOUNDATION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. PETER GOUWS (VICE PRESIDENT AND CFO)
(708) 216-3981
Entity
Organization

Contact information

Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(800) 424-6307
Mailing address
2 WESTBROOK CORPORATE CTR, S#600, WESTCHESTER, IL 60154-5702
(800) 424-6307

Taxonomy

Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
IL

Other

Enumeration date
08/05/2006
Last updated
09/02/2008
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