Provider Demographics
NPI:1225076706
Name:NORTHWESTERN SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:NORTHWESTERN SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:STRYKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-943-5427
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-0421
Mailing Address - Country:US
Mailing Address - Phone:847-770-6043
Mailing Address - Fax:
Practice Address - Street 1:676 N SAINT CLAIR ST
Practice Address - Street 2:STE 1525
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2927
Practice Address - Country:US
Practice Address - Phone:312-943-5427
Practice Address - Fax:312-266-0478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001621690OtherBLUE SHIELD
IL425230Medicare ID - Type Unspecified