Provider Demographics
NPI:1548206451
Name:NORTHWEST SUBURBAN MEDICAL ASSOCIATES, SC.
Entity Type:Organization
Organization Name:NORTHWEST SUBURBAN MEDICAL ASSOCIATES, SC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANGER SR.
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEMKE
Authorized Official - Suffix:
Authorized Official - Credentials:BUSINESS OFFICE
Authorized Official - Phone:847-255-7226
Mailing Address - Street 1:880 W CENTRAL RD
Mailing Address - Street 2:SUITE 8100
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2355
Mailing Address - Country:US
Mailing Address - Phone:847-255-5030
Mailing Address - Fax:847-255-0156
Practice Address - Street 1:880 W CENTRAL RD
Practice Address - Street 2:SUITE 8100
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2355
Practice Address - Country:US
Practice Address - Phone:847-255-5030
Practice Address - Fax:847-255-0156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5456730001Medicare NSC
IL455530Medicare ID - Type Unspecified