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General NPI Number Information
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NPI Number | 1205058617
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Entity Type | Organization
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Legal Business Name | NORTH SHORE FERTILITY, S.C.
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4250 DEMPSTER ST
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City | SKOKIE
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State | IL
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Zip | 60076-2008
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Country | US
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Telephone | 847-763-8850
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Fax | 847-763-8851
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Provider Business Mailing Address
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Address Line | 4250 DEMPSTER ST
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City | SKOKIE
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State | IL
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Zip | 60076-2008
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Country | US
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Telephone | 847-763-8850
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Fax | 847-763-8851
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TERRI L BAKKER
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Credential |
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Telephone | 312-735-0976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number |
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License Number State | IL
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