Provider Demographics
NPI:1538281159
Name:NORTH SHORE INTERNAL MEDICINE
Entity Type:Organization
Organization Name:NORTH SHORE INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:VELIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-763-3808
Mailing Address - Street 1:1430 N ARLINGTON HEIGHTS ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4823
Mailing Address - Country:US
Mailing Address - Phone:847-259-8226
Mailing Address - Fax:847-392-5260
Practice Address - Street 1:1430 N ARLINGTON HEIGHTS ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4823
Practice Address - Country:US
Practice Address - Phone:847-259-8226
Practice Address - Fax:847-392-5260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03608577207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212426Medicare PIN
F97468Medicare UPIN