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General NPI Number Information
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NPI Number | 1073869574
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Entity Type | Organization
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Legal Business Name | NORTHSTAR INTEGRATED HEALTH & PHYSICAL MEDICINE CENTER, S.C.
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Dates
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Enumeration Date | 08/02/2012
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Last Update Date | 02/11/2014
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Provider Practice Location Address
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Address Line | 4513 LINCOLN AVE #212
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City | LISLE
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State | IL
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Zip | 60532-1289
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Country | US
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Telephone | 630-795-1889
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Fax |
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Provider Business Mailing Address
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Address Line | 4513 LINCOLN AVE #212
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City | LISLE
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State | IL
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Zip | 60532-1289
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Country | US
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Telephone | 630-795-1889
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL RIESELMAN
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Credential |
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Telephone | 630-795-1889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0100X
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Taxonomy Name | Occupational Health Chiropractor
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License Number | 038010007
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163WP0000X
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Taxonomy Name | Pain Management Registered Nurse
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License Number | 041384754
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 036110569
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 036111510
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 036111510
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 036110569
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License Number State | IL
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Taxonomy #7
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070019141
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License Number State | IL
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Taxonomy #8
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 209009686
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License Number State | IL
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Taxonomy #9
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Taxonomy Code | 363LX0106X
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Taxonomy Name | Occupational Health Nurse Practitioner
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License Number | 209009686
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License Number State | IL
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Taxonomy #10
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State | IL
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Taxonomy #11
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209009686
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License Number State | IL
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