Provider Demographics
NPI:1376961524
Name:NORTHWESTERN MEDICAL FACULTY FOUNDATION
Entity Type:Organization
Organization Name:NORTHWESTERN MEDICAL FACULTY FOUNDATION
Other - Org Name:NORTHWESTERN MEDICAL GROUP/NM PIMARY & SPECVIALTY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:B
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:312-695-7860
Mailing Address - Street 1:680 N LAKE SHORE DR
Mailing Address - Street 2:SUITE #1000
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4546
Mailing Address - Country:US
Mailing Address - Phone:312-695-0665
Mailing Address - Fax:312-695-6594
Practice Address - Street 1:259 E ERIE ST
Practice Address - Street 2:SUITE 2300
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2987
Practice Address - Country:US
Practice Address - Phone:312-926-6101
Practice Address - Fax:312-926-6332
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWESTERN MEDICAL FACULTY FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-04
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies