Provider Demographics
NPI:1912321621
Name:NORTHWESTERN MEDICAL FACULTY FOUNDATION
Entity Type:Organization
Organization Name:NORTHWESTERN MEDICAL FACULTY FOUNDATION
Other - Org Name:NORTHWESTERN CENTER FOR SURGERY OF THE HAND
Other - Org Type:Other Name
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:B
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-695-9797
Mailing Address - Street 1:680 N LAKE SHORE DR
Mailing Address - Street 2:SUITE# 1000
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4546
Mailing Address - Country:US
Mailing Address - Phone:312-695-9797
Mailing Address - Fax:312-695-6680
Practice Address - Street 1:737 N MICHIGAN AVE
Practice Address - Street 2:SUITE#700
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2615
Practice Address - Country:US
Practice Address - Phone:312-695-5928
Practice Address - Fax:312-337-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies