Provider Demographics
NPI:1841306321
Name:NORTHWEST FAMILY PHYSICIANS LLC
Entity type:Organization
Organization Name:NORTHWEST FAMILY PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/MEDICAL RECORDS/CREDENTIALI
Authorized Official - Prefix:
Authorized Official - First Name:JO ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGHTFOOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-259-6200
Mailing Address - Street 1:1700 W CENTRAL RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2474
Mailing Address - Country:US
Mailing Address - Phone:847-259-6200
Mailing Address - Fax:847-259-3540
Practice Address - Street 1:1700 W CENTRAL RD
Practice Address - Street 2:SUITE 140
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2474
Practice Address - Country:US
Practice Address - Phone:847-259-6200
Practice Address - Fax:847-259-3540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01617214OtherBCBS
IL01617214OtherBCBS
I18443Medicare UPIN
L95084Medicare UPIN
IL732490Medicare PIN
P07904Medicare UPIN