Provider Demographics
NPI:1144331208
Name:NORTHWEST ENT ASSOCIATES, S.C.
Entity type:Organization
Organization Name:NORTHWEST ENT ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-467-1469
Mailing Address - Street 1:7447 W TALCOTT AVE STE 316
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7447 W TALCOTT AVE STE 316
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3714
Practice Address - Country:US
Practice Address - Phone:773-467-1285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360860903Medicaid
IL0360942493Medicaid
IL0361106343Medicaid
IL590010Medicare ID - Type Unspecified
IL0360860903Medicaid
ILG09276Medicare UPIN
IL0360942493Medicaid