MEDICARE: THE NORTH SHORE IV CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QI0500X	Infusion Therapy Clinic/Center	042620773	IL

General Provider Information

NPI Number	:	1194216408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE NORTH SHORE IV CENTER

Provider Business Mailing Address
First Line	:	200 GREEN BAY RD FL 2
Second Line	:
City	:	HIGHWOOD
State	:	IL
Zip	:	60040-1703
Country	:	US
Telephone Number	:	847-964-0326
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 GREEN BAY RD FL 2
Second Line	:
City	:	HIGHWOOD
State	:	IL
Zip	:	60040-1703
Country	:	US
Telephone Number	:	847-964-0326
Fax Number	:

Authorized Official
Title or Position	:	RECEPTION
Name	:	ERICA LAFFIN
Credential	:
Telephone Number	:	847-964-0326

Provider Enumeration Date	:	05/22/2018
Last Update Date	:	05/22/2018

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