Provider Demographics
NPI:1215156450
Name:NORTHWEST SUBURBAN URGENT CARE
Entity type:Organization
Organization Name:NORTHWEST SUBURBAN URGENT CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-356-9016
Mailing Address - Street 1:201 S. MILUAKEE AVE.
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046
Mailing Address - Country:US
Mailing Address - Phone:847-356-9016
Mailing Address - Fax:
Practice Address - Street 1:201 S. MILUAKEE AVE.
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046
Practice Address - Country:US
Practice Address - Phone:847-356-9016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL-01417-01242T00000X, 247100000X, 2471N0900X, 2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine TechnologyGroup - Multi-Specialty
No242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionistGroup - Multi-Specialty
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD14995OtherDR. JOE F. JACOBS UPIN#
ILC42529OtherDR. EJAZ RAHIM UPIN #
ILH62197OtherDR. NIGHAT NISAR UPIN#
ILC45845OtherDR. ROBERT MCMILLER UPIN#
ILIL-01417-01OtherRADIOLOGY MATERIAL LIC.
IL=========OtherEIN NUMBER