Provider Demographics
NPI:1710289509
Name:NORTHSHORE PRACTITIONERS INC
Entity Type:Organization
Organization Name:NORTHSHORE PRACTITIONERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-301-0413
Mailing Address - Street 1:6633 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3605
Mailing Address - Country:US
Mailing Address - Phone:773-301-0413
Mailing Address - Fax:
Practice Address - Street 1:1511 GLENWOOD ROAD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-0000
Practice Address - Country:US
Practice Address - Phone:773-935-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty