Healthcare Provider Details

I. General information

NPI: 1174694277
Provider Name (Legal Business Name): NORTH SHORE CARDIOLOGISTS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2006
Last Update Date: 12/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 WAUKEGAN RD SUITE 100
BANNOCKBURN IL
60015-1885
US

IV. Provider business mailing address

2151 WAUKEGAN RD SUITE 100
BANNOCKBURN IL
60015-1885
US

V. Phone/Fax

Practice location:
  • Phone: 847-444-5300
  • Fax:
Mailing address:
  • Phone: 847-444-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAY H ALEXANDER
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 847-444-5300