Provider Demographics
NPI:1295837417
Name:NORTH SHORE SURGICAL ASSOCIATES, S.C.
Entity Type:Organization
Organization Name:NORTH SHORE SURGICAL ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:NOLAN
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-918-9420
Mailing Address - Street 1:1900 HOLLISTER DR
Mailing Address - Street 2:SUITE # 210
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5233
Mailing Address - Country:US
Mailing Address - Phone:847-918-9420
Mailing Address - Fax:847-918-9494
Practice Address - Street 1:1900 HOLLISTER DR
Practice Address - Street 2:SUITE # 210
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5233
Practice Address - Country:US
Practice Address - Phone:847-918-9420
Practice Address - Fax:847-918-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1205829801OtherPERSONAL TYPE I NPI #
IL1205829801OtherPERSONAL TYPE I NPI #
ILW25201Medicare UPIN