Healthcare Provider Details

I. General information

NPI: 1952385932
Provider Name (Legal Business Name): PULMONARY PHYSICIANS OF THE NORTH SHORE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 WAUKEGAN RD SUITE 110
BANNOCKBURN IL
60015-1885
US

IV. Provider business mailing address

2151 WAUKEGAN RD SUITE 110
BANNOCKBURN IL
60015-1885
US

V. Phone/Fax

Practice location:
  • Phone: 847-236-1300
  • Fax: 847-236-9549
Mailing address:
  • Phone: 847-236-1300
  • Fax: 847-236-9549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number042005278
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number042005278
License Number StateIL

VIII. Authorized Official

Name: MRS. LYNN REED
Title or Position: BUSINESS MANAGER
Credential:
Phone: 847-236-1300