Provider Demographics
NPI:1598846883
Name:NORTH GROVES INTERNAL MEDICINE SC
Entity Type:Organization
Organization Name:NORTH GROVES INTERNAL MEDICINE SC
Other - Org Name:BUFFALO GROVE OFFICE
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSE PRACTITIONER/OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHODASH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:847-808-8223
Mailing Address - Street 1:1618 BARCLAY BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4523
Mailing Address - Country:US
Mailing Address - Phone:847-808-8223
Mailing Address - Fax:847-808-8276
Practice Address - Street 1:1618 BARCLAY BLVD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-4523
Practice Address - Country:US
Practice Address - Phone:847-808-8259
Practice Address - Fax:847-808-8276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty