Provider Demographics
NPI: | 1497483325 |
---|---|
Name: | NORTHSHORE UNIVERSITY HEALTHSYSTEM FACULTY PRACTICE ASSOCIATES |
Entity Type: | Organization |
Organization Name: | NORTHSHORE UNIVERSITY HEALTHSYSTEM FACULTY PRACTICE ASSOCIATES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | AVP |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CARRIE |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | BRADFORD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MHA |
Authorized Official - Phone: | 847-570-2041 |
Mailing Address - Street 1: | 2650 RIDGE AVE STE 1223 |
Mailing Address - Street 2: | |
Mailing Address - City: | EVANSTON |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60201-1700 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 847-570-2041 |
Mailing Address - Fax: | 847-733-5315 |
Practice Address - Street 1: | 1000 CENTRAL ST |
Practice Address - Street 2: | |
Practice Address - City: | EVANSTON |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60201-1777 |
Practice Address - Country: | US |
Practice Address - Phone: | 847-570-5270 |
Practice Address - Fax: | 847-570-5179 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-08-09 |
Last Update Date: | 2022-08-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
No | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Group - Multi-Specialty | |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
No | 207U00000X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Group - Multi-Specialty | |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 207ZB0001X | Allopathic & Osteopathic Physicians | Pathology | Blood Banking & Transfusion Medicine | Group - Multi-Specialty |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty |