Healthcare Provider Details

I. General information

NPI: 1356513246
Provider Name (Legal Business Name): NORTHSIDE EAR, NOSE AND THROAT, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9669 N. KENTON AVE SUITE 605
SKOKIE IL
60076-1248
US

IV. Provider business mailing address

9669 N. KENTON AVE SUITE 605
SKOKIE IL
60076-1248
US

V. Phone/Fax

Practice location:
  • Phone: 847-674-3626
  • Fax: 847-674-5250
Mailing address:
  • Phone: 847-674-3626
  • Fax: 847-674-5250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number036050064
License Number StateIL

VIII. Authorized Official

Name: DR. STEVEN DAVID HORWITZ
Title or Position: OWNER
Credential: MD
Phone: 847-674-3626