Provider Demographics
NPI:1588847727
Name:NORTH WEST HEALTH INSTITUTE SC
Entity Type:Organization
Organization Name:NORTH WEST HEALTH INSTITUTE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:
Authorized Official - Last Name:KATSNELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-593-8616
Mailing Address - Street 1:PO BOX 2526
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-6526
Mailing Address - Country:US
Mailing Address - Phone:847-593-8616
Mailing Address - Fax:847-593-8604
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:STE 201
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3361
Practice Address - Country:US
Practice Address - Phone:847-593-8616
Practice Address - Fax:847-593-8604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113246207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036113246Medicaid
IL212393Medicare PIN
IL036113246Medicaid