Provider Demographics
NPI:1093768228
Name:NORTH SHORE PHYSICIANS GROUP, LLC
Entity Type:Organization
Organization Name:NORTH SHORE PHYSICIANS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CROGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-251-1500
Mailing Address - Street 1:525 WINNETKA AVE
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-4050
Mailing Address - Country:US
Mailing Address - Phone:847-501-4060
Mailing Address - Fax:
Practice Address - Street 1:525 WINNETKA AVE
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-4050
Practice Address - Country:US
Practice Address - Phone:847-501-4060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213483Medicare PIN