Provider Demographics
NPI:1497788244
Name:VILLAGE OF WILMETTE
Entity Type:Organization
Organization Name:VILLAGE OF WILMETTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:AMORUSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-853-7599
Mailing Address - Street 1:1200 WILMETTE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2721
Mailing Address - Country:US
Mailing Address - Phone:847-251-2700
Mailing Address - Fax:847-853-7700
Practice Address - Street 1:1200 WILMETTE AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2721
Practice Address - Country:US
Practice Address - Phone:847-251-2700
Practice Address - Fax:847-853-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL348860Medicare ID - Type UnspecifiedPROVIDER NUMBER