Healthcare Provider Details

I. General information

NPI: 1144865635
Provider Name (Legal Business Name): NORTHSHORE PREMIER PRIMARY CARE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2019
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9211 WAUKEGAN RD
MORTON GROVE IL
60053-2102
US

IV. Provider business mailing address

9211 WAUKEGAN RD
MORTON GROVE IL
60053-2102
US

V. Phone/Fax

Practice location:
  • Phone: 847-529-7866
  • Fax:
Mailing address:
  • Phone: 847-529-7866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALVIA SABAHAT
Title or Position: CEO
Credential:
Phone: 847-529-7866