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General NPI Number Information
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NPI Number | 1356513246
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Entity Type | Organization
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Legal Business Name | NORTHSIDE EAR, NOSE AND THROAT, SC
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Dates
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Enumeration Date | 03/31/2008
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 9669 N. KENTON AVE SUITE 605
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City | SKOKIE
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State | IL
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Zip | 60076-1248
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Country | US
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Telephone | 847-674-3626
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Fax | 847-674-5250
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Provider Business Mailing Address
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Address Line | 9669 N. KENTON AVE SUITE 605
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City | SKOKIE
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State | IL
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Zip | 60076-1248
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Country | US
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Telephone | 847-674-3626
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Fax | 847-674-5250
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN DAVID HORWITZ
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Credential | MD
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Telephone | 847-674-3626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 036050064
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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