Provider Demographics
NPI:1376669663
Name:NORTHSHORE PHYSICIANS LTD.
Entity Type:Organization
Organization Name:NORTHSHORE PHYSICIANS LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:P
Authorized Official - Last Name:ATLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-588-7710
Mailing Address - Street 1:6374 N LINCOLN AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1275
Mailing Address - Country:US
Mailing Address - Phone:773-588-7710
Mailing Address - Fax:773-561-8977
Practice Address - Street 1:6374 N LINCOLN AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1275
Practice Address - Country:US
Practice Address - Phone:773-588-7710
Practice Address - Fax:773-561-8977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060-002113207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001615754OtherBCBSIL PROVIDER NUMBER
IL036047461Medicaid
IL0001615754OtherBCBSIL PROVIDER NUMBER
IL232031Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER