Healthcare Provider Details

I. General information

NPI: 1053453167
Provider Name (Legal Business Name): NORTHSHORE SLEEP MEDICINE, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 LAKE COOK RD STE 206
NORTHBROOK IL
60062-1451
US

IV. Provider business mailing address

1535 LAKE COOK RD STE 206
NORTHBROOK IL
60062-1451
US

V. Phone/Fax

Practice location:
  • Phone: 847-674-3600
  • Fax: 847-674-3639
Mailing address:
  • Phone: 847-674-3600
  • Fax: 847-674-3639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number042618664
License Number StateIL

VIII. Authorized Official

Name: MS. GIULIA ANDRA ALEXANDRU
Title or Position: OFFICE MANAGER
Credential:
Phone: 847-674-3600