Healthcare Provider Details

I. General information

NPI: 1013155167
Provider Name (Legal Business Name): NORTHSHORE UNIVERSITY HEALTHSYSTEM FACULTY PRACTICE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 KNOX AVE SUITE 103
SKOKIE IL
60076-1256
US

IV. Provider business mailing address

9701 KNOX AVE SUITE 103
SKOKIE IL
60076-1256
US

V. Phone/Fax

Practice location:
  • Phone: 847-933-6974
  • Fax: 847-933-6044
Mailing address:
  • Phone: 847-933-6974
  • Fax: 847-933-6044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0000646
License Number StateIL

VIII. Authorized Official

Name: DR. JOSEPH GOLBUS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-570-2503