Provider Demographics
NPI:1588743405
Name:NORTH SHORE PHYSICAL MEDICINE
Entity type:Organization
Organization Name:NORTH SHORE PHYSICAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-699-8888
Mailing Address - Street 1:241 GOLF MILL CENTER
Mailing Address - Street 2:SUITE 600
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714
Mailing Address - Country:US
Mailing Address - Phone:847-699-8888
Mailing Address - Fax:847-699-8830
Practice Address - Street 1:241 GOLF MILL CENTER
Practice Address - Street 2:SUITE 600
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714
Practice Address - Country:US
Practice Address - Phone:847-699-8888
Practice Address - Fax:847-699-8830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X, 111N00000X, 111N00000X, 111N00000X, 207R00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623055OtherBCBS OF IL
ILDC0192OtherRAILROAD MEDICARE
IL208972Medicare ID - Type Unspecified