Healthcare Provider Details

I. General information

NPI: 1942498209
Provider Name (Legal Business Name): NORTH SHERIDAN FAMILY MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 TEMPLE AVE
HIGHLAND PARK IL
60035-1435
US

IV. Provider business mailing address

396 TEMPLE AVE
HIGHLAND PARK IL
60035-1435
US

V. Phone/Fax

Practice location:
  • Phone: 847-432-7830
  • Fax: 847-432-7966
Mailing address:
  • Phone: 847-432-7830
  • Fax: 847-432-7966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number036071566
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JULIA GORELIK
Title or Position: OWNER/M.D.
Credential: M.D.
Phone: 847-432-7830