Provider Demographics
NPI:1063821916
Name:NORTHWESTERN MEDICAL FACULTY FOUNDATION
Entity Type:Organization
Organization Name:NORTHWESTERN MEDICAL FACULTY FOUNDATION
Other - Org Name:NORTHWESTERN MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SABINA
Authorized Official - Middle Name:
Authorized Official - Last Name:STRZEMINSKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-695-0646
Mailing Address - Street 1:5777 DEPT
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-4546
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 N WESTMORELAND RD
Practice Address - Street 2:LOWER LEVEL 88
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1674
Practice Address - Country:US
Practice Address - Phone:847-295-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0597400004Medicare NSC