Basic Information
| Provider Information | |||||||||
| NPI: | 1922051853 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH SHORE PHYSICIANS GROUP, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7380 N LINCOLN AVE | ||||||||
| Address2: | |||||||||
| City: | LINCOLNWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 607121705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475687400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7380 N LINCOLN AVE | ||||||||
| Address2: | |||||||||
| City: | LINCOLNWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 607121705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475687400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 07/11/2007 | ||||||||
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| AuthorizedOfficialLastName: | CROGHAN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED REPRESENTATIVE | ||||||||
| AuthorizedOfficialTelephone: | 8472511500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.