Provider Demographics
NPI:1154460004
Name:NORTHWEST PSYCHIATRIC SC
Entity Type:Organization
Organization Name:NORTHWEST PSYCHIATRIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRIVATE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-821-0590
Mailing Address - Street 1:1217 N MCHENRY ROAD
Mailing Address - Street 2:SUITE 236
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1108
Mailing Address - Country:US
Mailing Address - Phone:847-821-0590
Mailing Address - Fax:847-821-0720
Practice Address - Street 1:1217 N MCHENRY ROAD
Practice Address - Street 2:SUITE 236
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1108
Practice Address - Country:US
Practice Address - Phone:847-821-0590
Practice Address - Fax:847-821-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04932119OtherBC BS OF ILLINOIS
202769Medicare ID - Type Unspecified
IL04932119OtherBC BS OF ILLINOIS