Provider Demographics
NPI: | 1497701882 |
---|---|
Name: | NORTHSHORE UNIVERSITY HEALTHSYSTEM FACULTY PRACTICE ASSOCIATES |
Entity Type: | Organization |
Organization Name: | NORTHSHORE UNIVERSITY HEALTHSYSTEM FACULTY PRACTICE ASSOCIATES |
Other - Org Name: | NORTHSHORE UNIVERSITY HEALTHSYSTEM FACULTY PRACTICE ASSOCIATES |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JOSEPH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GOLBUS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 847-570-5270 |
Mailing Address - Street 1: | 1000 CENTRAL ST |
Mailing Address - Street 2: | |
Mailing Address - City: | EVANSTON |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60201-1777 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 847-570-5235 |
Mailing Address - Fax: | |
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: | 847-570-5235 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-26 |
Last Update Date: | 2009-02-12 |
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 |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IL | 1620385 | Other | BCBS GRP# |
IL | CG1022 | Other | MEDICARE RAILROAD PIN |
CG7704 | Other | MEDICARE RR PIN | |
IL | CC9279 | Other | MEDICARE RAILROAD PIN |
DB3329 | Other | MEDICARE RR PIN | |
IL | 1632989 | Other | BCBS GRP# |
DB4514 | Other | MEDICARE RR PIN | |
DB8753 | Other | MEDICARE RR PIN | |
IL | DB1510 | Other | MEDICARE RAILROAD PIN |
1633266 | Other | BCBS | |
IL | DB1601 | Other | MEDICARE RAILROAD PIN |
DB7197 | Other | MEDICARE RR PIN | |
IL | 1620385 | Other | BCBS GRP# |
1633266 | Other | BCBS | |
IL | 944351 | Medicare PIN | |
CG7704 | Other | MEDICARE RR PIN | |
IL | CG1022 | Other | MEDICARE RAILROAD PIN |
IL | 1632989 | Other | BCBS GRP# |
DB8753 | Other | MEDICARE RR PIN |