Basic Information
| Provider Information | |||||||||
| NPI: | 1023090925 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH SHORE ONCOLOGY-HEMATOLOGY ASSOCIATES, LTD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 HOLLISTER DR | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600485263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473676781 | ||||||||
| FaxNumber: | 8473677384 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 HOLLISTER DR | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600485263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473676781 | ||||||||
| FaxNumber: | 8473677384 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 03/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | COCHRAN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER / MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8473676781 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 4915289 | 01 | IL | BCBS | OTHER |