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General NPI Number Information
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NPI Number | 1821237017
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Entity Type | Organization
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Legal Business Name | NORTH SHORE CONSULTANTS IN NEPHROLOGY & HYPERTENSION, SC
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 02/11/2009
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Provider Practice Location Address
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Address Line | 2859 CENTRAL ST SUITE 133
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City | EVANSTON
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State | IL
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Zip | 60201-1234
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Country | US
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Telephone | 630-607-5871
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Fax | 630-628-9610
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Provider Business Mailing Address
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Address Line | 28 W LAKE ST SUITE 14
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City | ADDISON
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State | IL
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Zip | 60101-2709
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Country | US
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Telephone | 630-607-5871
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Fax | 630-628-9610
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Authorized Official
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Title or Position | PRESIDENT
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Name | GEORGE C KIM
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Credential | MD
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Telephone | 630-607-5871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 036099773
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License Number State | IL
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