Provider Demographics
NPI:1558549931
Name:NORTH SHORE MEDICINE S C
Entity Type:Organization
Organization Name:NORTH SHORE MEDICINE S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-674-4090
Mailing Address - Street 1:9669 KENTON AVE
Mailing Address - Street 2:SUITE 606
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1266
Mailing Address - Country:US
Mailing Address - Phone:847-674-4090
Mailing Address - Fax:847-674-6615
Practice Address - Street 1:9669 KENTON AVE
Practice Address - Street 2:SUITE 606
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1266
Practice Address - Country:US
Practice Address - Phone:847-674-4090
Practice Address - Fax:847-674-6615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD88657Medicare UPIN
IL458520Medicare PIN
IL1235184003Medicare PIN