Basic Information
| Provider Information | |||||||||
| NPI: | 1619980885 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH SHORE NEPHROLOGY LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 767 PARK AVE WEST | ||||||||
| Address2: | STE 260 | ||||||||
| City: | HIGHLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474327222 | ||||||||
| FaxNumber: | 8474329360 | ||||||||
| Practice Location | |||||||||
| Address1: | 767 PARK AVE W | ||||||||
| Address2: | STE 260 | ||||||||
| City: | HIGHLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474327222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 09/13/2007 | ||||||||
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| AuthorizedOfficialLastName: | PATEL | ||||||||
| AuthorizedOfficialFirstName: | SHALINI | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8474327222 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.