Provider Demographics
NPI:1265600886
Name:EVANSTON NORTHWESTERN HOSPITAL
Entity type:Organization
Organization Name:EVANSTON NORTHWESTERN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:MENICHELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-251-1098
Mailing Address - Street 1:107 CENTRAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-3201
Mailing Address - Country:US
Mailing Address - Phone:847-251-1098
Mailing Address - Fax:
Practice Address - Street 1:2650 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1718
Practice Address - Country:US
Practice Address - Phone:857-570-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-17
Last Update Date:2008-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital