NORTHWEST AMBUCARE NPI 1811965635

NPI Information

NORTHWEST AMBUCARE is a podiatric clinic center in Chicago, IL. NORTHWEST AMBUCARE NPI is 1811965635. The provider is registered as an organization entity type.

The provider's business location address is:

4040 W PETERSON AVE
CHICAGO, IL
ZIP 60646-019
Phone: (773) 267-0554
Fax: (773) 267-6258

The provider's authorized official is Tegan Augustine Thimesch .
The authorized official title is President and has the following contact phone number (773) 267-0554.

The CLIA number assigned to this NPI record is 14D1054852 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/8/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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