Provider Demographics
NPI:1851384366
Name:SASSOWER, NANCY W (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:W
Last Name:SASSOWER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 N CITYFRONT PLAZA DR STE 2505
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4588
Mailing Address - Country:US
Mailing Address - Phone:312-586-7560
Mailing Address - Fax:312-586-7563
Practice Address - Street 1:455 N CITYFRONT PLAZA DRIVE
Practice Address - Street 2:SUITE 2505
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-586-7560
Practice Address - Fax:312-586-7563
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093586207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036093586Medicaid
IL110154459OtherRR MEDICARE
IL110154459OtherRR MEDICARE
ILL56915Medicare PIN