Provider Demographics
NPI:1073623872
Name:NORTHWEST RHEUMATOLOGY SPECIALISTS, S.C.
Entity Type:Organization
Organization Name:NORTHWEST RHEUMATOLOGY SPECIALISTS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:I
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:847-364-0800
Mailing Address - Street 1:800 W BIESTERFIELD RD
Mailing Address - Street 2:STE 4003
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-7306
Mailing Address - Country:US
Mailing Address - Phone:847-364-0800
Mailing Address - Fax:847-364-0854
Practice Address - Street 1:800 W BIESTERFIELD RD
Practice Address - Street 2:STE 4003
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-7306
Practice Address - Country:US
Practice Address - Phone:847-364-0800
Practice Address - Fax:847-364-0854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053094207RR0500X
IL036078438207RR0500X
IL036085718207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053094Medicaid
D13967Medicare UPIN
IL618600Medicare ID - Type Unspecified