Provider Demographics
NPI:1760504526
Name:NORTH SHORE CENTER FOR WEIGHT MANAGEMENT
Entity Type:Organization
Organization Name:NORTH SHORE CENTER FOR WEIGHT MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAKS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-730-1102
Mailing Address - Street 1:89 EVERGREEN CT
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5066
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2150 PFINGSTEN RD
Practice Address - Street 2:SUITE 2200
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1361
Practice Address - Country:US
Practice Address - Phone:847-730-1102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty