Provider Demographics
NPI:1801960828
Name:PHYSICIANS OF THE NORTH SHORE LTD
Entity type:Organization
Organization Name:PHYSICIANS OF THE NORTH SHORE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHOLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-679-3411
Mailing Address - Street 1:9555 GROSS POINT RD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1356
Mailing Address - Country:US
Mailing Address - Phone:847-679-3411
Mailing Address - Fax:847-675-7450
Practice Address - Street 1:9555 GROSS POINT RD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1356
Practice Address - Country:US
Practice Address - Phone:847-679-3411
Practice Address - Fax:847-675-7450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071271207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036071271OtherSTATE LICENSE
IL5347420001Medicare NSC