Healthcare Provider Details

I. General information

NPI: 1689658353
Provider Name (Legal Business Name): NORTH SHORE LUNG SPECIALISTS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 W CENTRAL RD SUITE 107
ARLINGTON HEIGHTS IL
60005-2490
US

IV. Provider business mailing address

1614 W CENTRAL RD SUITE 107
ARLINGTON HEIGHTS IL
60005-2490
US

V. Phone/Fax

Practice location:
  • Phone: 847-818-1184
  • Fax: 847-818-0980
Mailing address:
  • Phone: 847-818-1184
  • Fax: 847-818-0980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number042-006114
License Number StateIL

VIII. Authorized Official

Name: MS. KIM L ROHTER
Title or Position: MANAGER
Credential:
Phone: 847-818-1184