Provider Demographics
NPI:1356760573
Name:NORTH SHORE AESTHETICS PC
Entity type:Organization
Organization Name:NORTH SHORE AESTHETICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLECHTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-393-4770
Mailing Address - Street 1:1404 TECHNY RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062
Mailing Address - Country:US
Mailing Address - Phone:847-393-4770
Mailing Address - Fax:224-326-2239
Practice Address - Street 1:1404 TECHNY RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062
Practice Address - Country:US
Practice Address - Phone:847-393-4770
Practice Address - Fax:224-326-2239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF100145656OtherPTAN