Provider Demographics
NPI:1316177413
Name:NORTHSHORE UNIVERSITY HEALTHSYSTEM
Entity type:Organization
Organization Name:NORTHSHORE UNIVERSITY HEALTHSYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT CERTIFIED
Authorized Official - Prefix:MISS
Authorized Official - First Name:SAHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:NIMROUZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-844-2495
Mailing Address - Street 1:5433 N FOREST GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1523
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2650 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1718
Practice Address - Country:US
Practice Address - Phone:773-570-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital