Provider Demographics
NPI:1760729396
Name:NORTHWESTERN MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:NORTHWESTERN MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDOCRINOLOGY FELLOW
Authorized Official - Prefix:
Authorized Official - First Name:RONG
Authorized Official - Middle Name:RONG
Authorized Official - Last Name:GUO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-225-6542
Mailing Address - Street 1:675 N SAINT CLAIR ST
Mailing Address - Street 2:SUITE 14-100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5975
Mailing Address - Country:US
Mailing Address - Phone:480-225-6542
Mailing Address - Fax:
Practice Address - Street 1:675 N SAINT CLAIR ST
Practice Address - Street 2:SUITE 14-100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5975
Practice Address - Country:US
Practice Address - Phone:480-225-6542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital