Provider Demographics
NPI:1235471228
Name:NORTHWESTERN MEDICAL FACULTY FOUDNATION
Entity Type:Organization
Organization Name:NORTHWESTERN MEDICAL FACULTY FOUDNATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF, DIVISION ONF NEPHROLOGY
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:QUAGGIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-503-1531
Mailing Address - Street 1:303 E SUPERIOR ST
Mailing Address - Street 2:LURIE 10-109
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3015
Mailing Address - Country:US
Mailing Address - Phone:312-503-1531
Mailing Address - Fax:312-503-6262
Practice Address - Street 1:303 E SUPERIOR ST
Practice Address - Street 2:LURIE 10-109
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3015
Practice Address - Country:US
Practice Address - Phone:312-503-1531
Practice Address - Fax:312-503-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036131841261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty