Provider Demographics
NPI:1134281173
Name:GREATER NORTHWEST MEDICAL GROUP
Entity Type:Organization
Organization Name:GREATER NORTHWEST MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:AEMISEGGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-803-8613
Mailing Address - Street 1:1247 MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2464
Mailing Address - Country:US
Mailing Address - Phone:847-803-8613
Mailing Address - Fax:
Practice Address - Street 1:1247 MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2464
Practice Address - Country:US
Practice Address - Phone:847-803-8613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty