Provider Demographics
NPI:1457565426
Name:NORTHWESTERN PERINATAL ASSOCIATES, S.C.
Entity Type:Organization
Organization Name:NORTHWESTERN PERINATAL ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDI
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRETZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:312-981-4350
Mailing Address - Street 1:680 N LAKE SHORE DRIVE
Mailing Address - Street 2:SUITE 1428
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-8700
Mailing Address - Country:US
Mailing Address - Phone:312-981-4350
Mailing Address - Fax:312-981-4363
Practice Address - Street 1:680 N LAKE SHORE DRIVE
Practice Address - Street 2:SUITE 1428
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-8700
Practice Address - Country:US
Practice Address - Phone:312-981-4350
Practice Address - Fax:312-981-4363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-058725207VG0400X, 207VM0101X, 207VX0000X
IL036058725207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative MedicineGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058725Medicaid
D14599Medicare UPIN