Provider Demographics
NPI:1538476833
Name:NORTHSHORE SURGICARE
Entity Type:Organization
Organization Name:NORTHSHORE SURGICARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:RIEGELHAUPT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-729-4710
Mailing Address - Street 1:P.O. BOX 2352
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-6352
Mailing Address - Country:US
Mailing Address - Phone:847-729-4770
Mailing Address - Fax:847-729-4746
Practice Address - Street 1:1775 GLENVIEW RD.
Practice Address - Street 2:SUITE #115
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-6352
Practice Address - Country:US
Practice Address - Phone:847-729-4710
Practice Address - Fax:847-729-4746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty