Provider Demographics
NPI:1174646285
Name:NORTHWEST MEDICAL CLINIC SC
Entity Type:Organization
Organization Name:NORTHWEST MEDICAL CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SATISH
Authorized Official - Middle Name:N
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-259-8777
Mailing Address - Street 1:1614 W CENTRAL RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2490
Mailing Address - Country:US
Mailing Address - Phone:847-259-8777
Mailing Address - Fax:
Practice Address - Street 1:1614 W CENTRAL RD
Practice Address - Street 2:SUITE 209
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2490
Practice Address - Country:US
Practice Address - Phone:847-259-8777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042617076207Q00000X, 207QG0300X
IL036126253261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL6775Medicare PIN
IL577960Medicare PIN
ILH12979Medicare UPIN
IL577960Medicare PIN