Provider Demographics
NPI:1063686459
Name:NORTH SHORE MEDICAL ASSOCIATES LTD
Entity type:Organization
Organization Name:NORTH SHORE MEDICAL ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:OSHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-317-1717
Mailing Address - Street 1:2101 WAUKEGAN RD STE 104
Mailing Address - Street 2:
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1836
Mailing Address - Country:US
Mailing Address - Phone:847-317-1717
Mailing Address - Fax:847-317-9305
Practice Address - Street 1:2101 WAUKEGAN RD STE 104
Practice Address - Street 2:
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1836
Practice Address - Country:US
Practice Address - Phone:847-317-1717
Practice Address - Fax:847-317-9305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066116207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL316010188OtherBLUE CROSS BLUE SHIELD
IL0031601088Medicaid
IL010020197OtherRAILROAD MEDICARE
IL0031601088Medicaid