Provider Demographics
NPI:1336395342
Name:NORTHWESTERN DEPARTMENT OF NEUROSURGERY
Entity type:Organization
Organization Name:NORTHWESTERN DEPARTMENT OF NEUROSURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:MOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-922-0898
Mailing Address - Street 1:676 N SAINT CLAIR ST
Mailing Address - Street 2:SUITE 2210
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2927
Mailing Address - Country:US
Mailing Address - Phone:312-922-0898
Mailing Address - Fax:
Practice Address - Street 1:676 N SAINT CLAIR ST
Practice Address - Street 2:SUITE 2210
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2927
Practice Address - Country:US
Practice Address - Phone:312-922-0898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-09
Last Update Date:2008-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.121196282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital