Provider Demographics
NPI:1508901307
Name:NORTH SHORE CENTER FOR MEDICAL AESTHETICS, LTD.
Entity Type:Organization
Organization Name:NORTH SHORE CENTER FOR MEDICAL AESTHETICS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-480-1111
Mailing Address - Street 1:1535 LAKE COOK RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1447
Mailing Address - Country:US
Mailing Address - Phone:847-480-1111
Mailing Address - Fax:
Practice Address - Street 1:1535 LAKE COOK RD
Practice Address - Street 2:SUITE 401
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1447
Practice Address - Country:US
Practice Address - Phone:847-480-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633347OtherBLUE CROSS BLUE SHIELD
IL01633347OtherBLUE CROSS BLUE SHIELD