Provider Demographics
NPI:1528107794
Name:NORTH SHORE INFUSION LTD
Entity type:Organization
Organization Name:NORTH SHORE INFUSION LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURDOSIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-492-3040
Mailing Address - Street 1:5230 OLD ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1034
Mailing Address - Country:US
Mailing Address - Phone:847-492-3040
Mailing Address - Fax:847-492-3045
Practice Address - Street 1:1800 SHERMAN AVE
Practice Address - Street 2:STE 350
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3777
Practice Address - Country:US
Practice Address - Phone:847-492-3040
Practice Address - Fax:847-492-3045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212041Medicare ID - Type Unspecified