Provider Demographics
NPI:1255414926
Name:NORTHWEST PULMONARY ASSOCIATES, S.C.
Entity type:Organization
Organization Name:NORTHWEST PULMONARY ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:JANKELOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-631-2180
Mailing Address - Street 1:7447 W TALCOTT AVE
Mailing Address - Street 2:SUITE 542
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3745
Mailing Address - Country:US
Mailing Address - Phone:773-631-2180
Mailing Address - Fax:773-631-5947
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:SUITE 542
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-631-2180
Practice Address - Fax:773-631-5947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042007411207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1477574127OtherNPI
IL036101642Medicaid
IL036056892Medicaid
IL036099147Medicaid
IL036105579Medicaid
IL036115740Medicaid
IL036101642Medicaid
IL036105579Medicaid
IL036115740Medicaid
471610Medicare ID - Type Unspecified
ILI29574Medicare UPIN
IL036099147Medicaid