Provider Demographics
NPI:1063546166
Name:DIGESTIVE DISEASE ASSOCIATES OF THE NORTH SHORE S C
Entity type:Organization
Organization Name:DIGESTIVE DISEASE ASSOCIATES OF THE NORTH SHORE S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-486-9610
Mailing Address - Street 1:2551 COMPASS RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8045
Mailing Address - Country:US
Mailing Address - Phone:847-486-9610
Mailing Address - Fax:847-486-9617
Practice Address - Street 1:2551 COMPASS RD
Practice Address - Street 2:SUITE 120
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8045
Practice Address - Country:US
Practice Address - Phone:847-486-9610
Practice Address - Fax:847-486-9617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042617789207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209321Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER