=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801960828
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYSICIANS OF THE NORTH SHORE LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2006
-----------------------------------------------------
Last Update Date | 09/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9555 GROSS POINT RD
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60076-1356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-679-3411
-----------------------------------------------------
Fax | 847-675-7450
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9555 GROSS POINT RD
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60076-1356
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-679-3411
-----------------------------------------------------
Fax | 847-675-7450
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | M.D.
-----------------------------------------------------
Name | DR. STEVEN P. SHOLL
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 847-679-3411
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 036071271
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------