Provider Demographics
NPI:1831301688
Name:NORTHWEST MEDICAL CENTER S.C.
Entity Type:Organization
Organization Name:NORTHWEST MEDICAL CENTER S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAZEJ
Authorized Official - Middle Name:
Authorized Official - Last Name:LOJEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-292-8999
Mailing Address - Street 1:1022 N NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1831
Mailing Address - Country:US
Mailing Address - Phone:847-292-8999
Mailing Address - Fax:847-292-9126
Practice Address - Street 1:1022 N NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1831
Practice Address - Country:US
Practice Address - Phone:847-292-8999
Practice Address - Fax:847-292-9126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG82159Medicare UPIN
IL492940Medicare ID - Type Unspecified