Provider Demographics
NPI:1356513246
Name:NORTHSIDE EAR, NOSE AND THROAT, SC
Entity type:Organization
Organization Name:NORTHSIDE EAR, NOSE AND THROAT, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HORWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-674-3626
Mailing Address - Street 1:9669 N. KENTON AVE
Mailing Address - Street 2:SUITE 605
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1248
Mailing Address - Country:US
Mailing Address - Phone:847-674-3626
Mailing Address - Fax:847-674-5250
Practice Address - Street 1:9669 N. KENTON AVE
Practice Address - Street 2:SUITE 605
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1248
Practice Address - Country:US
Practice Address - Phone:847-674-3626
Practice Address - Fax:847-674-5250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036050064261QM2500X
207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036050064Medicaid
IL036050064Medicaid
ILAH6289361OtherDEA NUMBER
ILC37627Medicare UPIN
409051Medicare PIN