MEDICARE: ADVOCATE NORTH SIDE HEALTH NETWORK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336I0012X	Institutional Pharmacy

General Provider Information

NPI Number	:	1114645470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVOCATE NORTH SIDE HEALTH NETWORK

Provider Business Mailing Address
First Line	:	PO BOX 208
Second Line	:
City	:	SHEBOYGAN
State	:	WI
Zip	:	53082-0208
Country	:	US
Telephone Number	:	920-803-3266
Fax Number	:	920-459-2634

Provider Business Practice Location Address
First Line	:	836 W WELLINGTON AVE STE 1801
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5147
Country	:	US
Telephone Number	:	872-843-3160
Fax Number	:	872-843-3165

Authorized Official
Title or Position	:	VP MANAGED HEALTH
Name	:	KARA RICHARDSON
Credential	:
Telephone Number	:	980-416-4068

Provider Enumeration Date	:	08/22/2022
Last Update Date	:	01/28/2026

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