MEDICARE: ADVOCATE NORTH SIDE HEALTH NETWORK

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	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1821203621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVOCATE NORTH SIDE HEALTH NETWORK

Provider Business Mailing Address
First Line	:	836 W WELLINGTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5147
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4015 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2593
Country	:	US
Telephone Number	:	773-404-0447
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUSAN NORDSTROM LOPEZ
Credential	:
Telephone Number	:	773-296-7081

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/23/2008

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