Provider Demographics
NPI:1649469099
Name:NORTHWESTERN ORTHOPAEDIC INSTITUTE
Entity type:Organization
Organization Name:NORTHWESTERN ORTHOPAEDIC INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:CPC CPC-H CPC-I CPED
Authorized Official - Phone:312-475-5628
Mailing Address - Street 1:680 N LAKE SHORE DRIVE, SUITE 924
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-664-6848
Mailing Address - Fax:
Practice Address - Street 1:680 N LAKE SHORE DRIVE, SUITE 924
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-475-5628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-053824207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6147930002Medicare NSC