Provider Demographics
NPI:1144257387
Name:NORTHWESTERN NASAL & SINUS
Entity type:Organization
Organization Name:NORTHWESTERN NASAL & SINUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:TASSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-266-6673
Mailing Address - Street 1:676 N ST S CLAIR
Mailing Address - Street 2:#1575 NORTHWESTERN NASAL & SINUS
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-266-6673
Mailing Address - Fax:213-266-3680
Practice Address - Street 1:676 N ST S CLAIR
Practice Address - Street 2:#1575 NORTHWESTERN NASAL & SINUS
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-266-6673
Practice Address - Fax:213-266-3680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL92562972085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
208925Medicare ID - Type UnspecifiedIDTF