Provider Demographics
NPI:1629199344
Name:NORTH SUBURBAN MEDICAL OFFICE, LTD
Entity Type:Organization
Organization Name:NORTH SUBURBAN MEDICAL OFFICE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-855-0300
Mailing Address - Street 1:1445 N HUNT CLUB RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2603
Mailing Address - Country:US
Mailing Address - Phone:847-855-0300
Mailing Address - Fax:847-855-7950
Practice Address - Street 1:1445 N HUNT CLUB RD
Practice Address - Street 2:SUITE 301
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2603
Practice Address - Country:US
Practice Address - Phone:847-855-0300
Practice Address - Fax:847-855-7950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209341Medicare PIN