=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114068293
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHSHORE HEALTH PARTNERS LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2007
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5140 N CALIFORNIA AVE SUITE 600
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60625-3645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-878-3326
-----------------------------------------------------
Fax | 773-878-3614
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5140 N CALIFORNIA AVE SUITE 600
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60625-3645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-878-3326
-----------------------------------------------------
Fax | 773-878-3614
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ARMINIO SURUCCI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 773-878-3326
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------