Provider Demographics
NPI:1710075833
Name:NORTHBROOK OCCUPATIONAL MEDICINE CT
Entity Type:Organization
Organization Name:NORTHBROOK OCCUPATIONAL MEDICINE CT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:OSIPOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD MPH
Authorized Official - Phone:847-498-5300
Mailing Address - Street 1:NOME 605 ACADEMY DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062
Mailing Address - Country:US
Mailing Address - Phone:847-498-5300
Mailing Address - Fax:847-498-5366
Practice Address - Street 1:605 ACADEMY DR
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062
Practice Address - Country:US
Practice Address - Phone:847-498-5300
Practice Address - Fax:847-498-5366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C43977Medicare UPIN