Provider Demographics
NPI:1609120278
Name:NWCP PEDIATRICS LLC
Entity Type:Organization
Organization Name:NWCP PEDIATRICS LLC
Other - Org Name:THE NORTHWESTERN CHILDREN'S PRACTICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PEDIATRICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-642-5515
Mailing Address - Street 1:680 N LAKE SHORE DR
Mailing Address - Street 2:123
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4546
Mailing Address - Country:US
Mailing Address - Phone:312-642-5515
Mailing Address - Fax:312-642-0753
Practice Address - Street 1:680 N LAKE SHORE DR
Practice Address - Street 2:123
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4546
Practice Address - Country:US
Practice Address - Phone:312-642-5515
Practice Address - Fax:312-642-0753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty