Provider Demographics
NPI:1104195809
Name:NORTH SUBURBAN FAMILY MEDICINE LTD
Entity type:Organization
Organization Name:NORTH SUBURBAN FAMILY MEDICINE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:HOLLY
Authorized Official - Last Name:SAMUELSOHN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:847-795-0900
Mailing Address - Street 1:950 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-3540
Mailing Address - Country:US
Mailing Address - Phone:847-795-0900
Mailing Address - Fax:847-795-0955
Practice Address - Street 1:150 N RIVER RD
Practice Address - Street 2:SUITE 310
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1272
Practice Address - Country:US
Practice Address - Phone:847-795-0900
Practice Address - Fax:847-795-0955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042-619911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty