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General NPI Number Information
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NPI Number | 1033176789
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Entity Type | Organization
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Legal Business Name | NORTH SHORE RHEUMATOLOGY
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 900 N WESTMORELAND RD SUITE 222
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City | LAKE FOREST
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State | IL
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Zip | 60045-1674
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Country | US
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Telephone | 847-234-6121
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Fax |
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Provider Business Mailing Address
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Address Line | 900 N WESTMORELAND RD SUITE 222
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City | LAKE FOREST
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State | IL
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Zip | 60045-1674
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Country | US
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Telephone | 847-234-6121
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OF CORPORATION
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Name | DR. JENNIFER CAPEZIO
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Credential | MD
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Telephone | 847-234-6121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State | IL
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