Provider Demographics
NPI:1013021922
Name:NORTH SHORE UROGYNECOLOGY LTD
Entity Type:Organization
Organization Name:NORTH SHORE UROGYNECOLOGY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:GANDHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-234-1100
Mailing Address - Street 1:351 GREENLEAF AVE
Mailing Address - Street 2:E
Mailing Address - City:PARK CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60085-5701
Mailing Address - Country:US
Mailing Address - Phone:847-234-1100
Mailing Address - Fax:847-775-0703
Practice Address - Street 1:351 GREENLEAF AVE
Practice Address - Street 2:E
Practice Address - City:PARK CITY
Practice Address - State:IL
Practice Address - Zip Code:60085-5701
Practice Address - Country:US
Practice Address - Phone:847-234-1100
Practice Address - Fax:847-775-0703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-101308207VF0040X
IL036101308207VG0400X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Single Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21179Medicare PIN
IL211179Medicare PIN
ILH42764Medicare UPIN