Provider Demographics
NPI:1689658353
Name:NORTH SHORE LUNG SPECIALISTS, S.C.
Entity Type:Organization
Organization Name:NORTH SHORE LUNG SPECIALISTS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-818-1184
Mailing Address - Street 1:1614 W CENTRAL RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2490
Mailing Address - Country:US
Mailing Address - Phone:847-818-1184
Mailing Address - Fax:847-818-0980
Practice Address - Street 1:1614 W CENTRAL RD
Practice Address - Street 2:SUITE 107
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2490
Practice Address - Country:US
Practice Address - Phone:847-818-1184
Practice Address - Fax:847-818-0980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-006114207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
476613Medicare ID - Type Unspecified