Provider Demographics
NPI:1154855781
Name:NORTHLAKE PHYSICIANS GROUP
Entity Type:Organization
Organization Name:NORTHLAKE PHYSICIANS GROUP
Other - Org Name:THE NESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-452-4565
Mailing Address - Street 1:7300 N CICERO AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1641
Mailing Address - Country:US
Mailing Address - Phone:224-392-9889
Mailing Address - Fax:
Practice Address - Street 1:23699 QUAIL LANE
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-7334
Practice Address - Country:US
Practice Address - Phone:985-334-4040
Practice Address - Fax:985-626-6549
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NESS HEALTHCARE NFP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-20
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty