Provider Demographics
NPI:1972674059
Name:NORTH SHORE MEDICAL, LTD
Entity Type:Organization
Organization Name:NORTH SHORE MEDICAL, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VERN
Authorized Official - Middle Name:
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-433-5864
Mailing Address - Street 1:1954 1ST ST STE 335
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3104
Mailing Address - Country:US
Mailing Address - Phone:847-433-5864
Mailing Address - Fax:847-433-5851
Practice Address - Street 1:1780 GREEN BAY RD STE 202
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3276
Practice Address - Country:US
Practice Address - Phone:847-433-5864
Practice Address - Fax:847-433-5851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty