Provider Demographics
NPI:1073869574
Name:NORTHSTAR INTEGRATED HEALTH & PHYSICAL MEDICINE CENTER, S.C.
Entity type:Organization
Organization Name:NORTHSTAR INTEGRATED HEALTH & PHYSICAL MEDICINE CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIESELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-795-1889
Mailing Address - Street 1:4513 LINCOLN AVE
Mailing Address - Street 2:#212
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-1289
Mailing Address - Country:US
Mailing Address - Phone:630-795-1889
Mailing Address - Fax:
Practice Address - Street 1:4513 LINCOLN AVE
Practice Address - Street 2:#212
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1289
Practice Address - Country:US
Practice Address - Phone:630-795-1889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010007111NX0100X
IL041384754163WP0000X, 163WP0000X
IL036110569204D00000X, 208VP0000X
IL036111510207VG0400X, 208D00000X
IL070019141225100000X
IL209009686363LP2300X, 363LX0106X, 363LF0000X, 364SH1100X, 363LF0000X
IL2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Multi-Specialty
No163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational HealthGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No364SH1100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHolisticGroup - Multi-Specialty