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General NPI Number Information
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NPI Number | 1366843682
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Entity Type | Organization
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Legal Business Name | ENDOCRINOLOGY CONSULTS AND CARE SERVICE CORPORATION
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Dates
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Enumeration Date | 09/05/2014
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Last Update Date | 03/01/2016
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Provider Practice Location Address
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Address Line | 3048 W PETERSON AVE
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City | CHICAGO
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State | IL
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Zip | 60659-3720
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Country | US
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Telephone | 773-381-0517
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Fax | 773-381-0617
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Provider Business Mailing Address
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Address Line | 1135 RIDGE RD
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City | WILMETTE
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State | IL
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Zip | 60091-1567
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Country | US
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Telephone | 847-906-4910
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUSAN SHAPIRO BRAITHWAITE
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Credential | M.D.
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Telephone | 847-906-4910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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