Request medical staff 2026

1. Click ‘Get Form’ to open the request medical staff application in the editor.
2. Begin by filling in your Provider Name, Degree, and Date of Birth (DOB) in the required fields outlined in red.
3. Provide your Home Address, including City, State, and Zip Code. Ensure your contact information such as Email and Cell Phone is accurate.
4. Complete the sections for Primary and Secondary Clinical Offices, including their respective addresses and contact details.
5. Indicate whether you have an active Illinois Medical License and Controlled Substance License by selecting 'Yes' or 'No'. If applicable, provide dates for any pending applications.
6. Select your Specialty from the dropdown menu and indicate if inpatient hospital privileges are required.
7. Choose your proposed start date and confirm if you are joining Northwestern Medicine Physician Network (NMPN).
8. Select the NM facilities where you wish to apply, marking one as your primary location.
9. Once all fields are completed, click ‘Submit this Form’ to send your application along with a current CV via email.

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