Healthcare Provider Details

I. General information

NPI: 1821179110
Provider Name (Legal Business Name): NORTH GROVES INTERNAL MEDICINE SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 OAK ST STE 111
WINNETKA IL
60093-2523
US

IV. Provider business mailing address

1618 BARCLAY BLVD
BUFFALO GROVE IL
60089-4523
US

V. Phone/Fax

Practice location:
  • Phone: 847-784-8870
  • Fax: 847-784-8876
Mailing address:
  • Phone: 847-808-8223
  • Fax: 847-808-8276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. NANCY CHODASH
Title or Position: NURSE PRACTITIONER/OFFICE MANAGER
Credential: NP
Phone: 847-808-8223