Provider Demographics
NPI:1689729261
Name:THE NORTHWESTERN CHILDREN'S PRACTICE
Entity Type:Organization
Organization Name:THE NORTHWESTERN CHILDREN'S PRACTICE
Other - Org Name:MARC WEISSBLUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISSBLUTH
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:2007-01-24
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty