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General NPI Number Information
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NPI Number | 1821179110
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Entity Type | Organization
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Legal Business Name | NORTH GROVES INTERNAL MEDICINE SC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 04/29/2013
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Provider Practice Location Address
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Address Line | 800 OAK ST STE 111
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City | WINNETKA
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State | IL
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Zip | 60093-2523
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Country | US
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Telephone | 847-784-8870
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Fax | 847-784-8876
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Provider Business Mailing Address
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Address Line | 1618 BARCLAY BLVD
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-4523
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Country | US
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Telephone | 847-808-8223
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Fax | 847-808-8276
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OFFICE MANAGER
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Name | DR. NANCY CHODASH
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Credential | NP
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Telephone | 847-808-8223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | IL
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