Organization
NORTHWESTERN MEMORIAL HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK HUTTON (PROGRAM DIRECTOR)
(312) 926-3264
Entity
Organization
Contact information
Practice address
201 E HURON ST, GALTER 2-246, CHICAGO, IL 60611-3197
(312) 926-3264
Mailing address
201 E HURON ST, GALTER 2-246, CHICAGO, IL 60611-3197
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
018-001815
IL
Other
Enumeration date
07/21/2011
Last updated
07/21/2011
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