Provider Demographics
NPI:1760638605
Name:WATERTOWER CLINIC ASSOCIATES
Entity Type:Organization
Organization Name:WATERTOWER CLINIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-654-2154
Mailing Address - Street 1:845 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 948E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2252
Mailing Address - Country:US
Mailing Address - Phone:312-654-2154
Mailing Address - Fax:312-867-7841
Practice Address - Street 1:845 N MICHIGAN AVE
Practice Address - Street 2:SUITE 948E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2252
Practice Address - Country:US
Practice Address - Phone:312-654-2154
Practice Address - Fax:312-867-7841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-066567174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty