Provider Demographics
NPI:1093911745
Name:NORTH SHORE ADVANCED SURGERY, SC
Entity Type:Organization
Organization Name:NORTH SHORE ADVANCED SURGERY, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHARPLESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-735-0067
Mailing Address - Street 1:660 N WESTMORELAND RD STE 303
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1659
Mailing Address - Country:US
Mailing Address - Phone:847-735-0067
Mailing Address - Fax:847-735-1398
Practice Address - Street 1:660 N WESTMORELAND RD STE 303
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1659
Practice Address - Country:US
Practice Address - Phone:847-735-0067
Practice Address - Fax:847-735-1398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL360908992086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208108Medicare ID - Type UnspecifiedGROUP NUMBER