Healthcare Provider Details

I. General information

NPI: 1932684982
Provider Name (Legal Business Name): NORTH SHORE PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 WAUKEGAN RD STE 12
MORTON GROVE IL
60053-2127
US

IV. Provider business mailing address

PO BOX 1123
JACKSON MI
49204-1123
US

V. Phone/Fax

Practice location:
  • Phone: 847-213-5444
  • Fax:
Mailing address:
  • Phone: 517-787-6440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD NOREN
Title or Position: PRESIDENT / OWNER
Credential: MD
Phone: 847-836-7015