Provider Demographics
NPI:1407821572
Name:DOCTORS OF THE NORTH SHORE SC
Entity Type:Organization
Organization Name:DOCTORS OF THE NORTH SHORE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PFEIFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-967-5010
Mailing Address - Street 1:6131 W DEMPSTER
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053
Mailing Address - Country:US
Mailing Address - Phone:847-967-5010
Mailing Address - Fax:847-967-5147
Practice Address - Street 1:6131 W DEMPSTER
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053
Practice Address - Country:US
Practice Address - Phone:847-967-5010
Practice Address - Fax:847-967-5147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632926OtherBLUE CROSS BLUE SHIELD
IL01632926OtherBLUE CROSS BLUE SHIELD