Provider Demographics
NPI:1225344906
Name:NORTHWEST PRIMARY CARE PC
Entity Type:Organization
Organization Name:NORTHWEST PRIMARY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVANG
Authorized Official - Middle Name:N
Authorized Official - Last Name:DHARIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-458-4500
Mailing Address - Street 1:2214 HUNTINGTON DR N
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-4419
Mailing Address - Country:US
Mailing Address - Phone:847-458-4500
Mailing Address - Fax:847-458-4503
Practice Address - Street 1:2214 HUNTINGTON DR N
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-4419
Practice Address - Country:US
Practice Address - Phone:847-458-4500
Practice Address - Fax:847-458-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6276OtherPTAN
ILIL6276OtherPTAN
IL6278OtherPTAN
ILIL6277OtherPTAN
IL6277OtherPTAN
ILIL6278OtherPTAN
ILH38244Medicare UPIN