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NPI Code Detail

MEDICARE: ENDOCRINOLOGY CONSULTS AND CARE SERVICE CORPORATION

MEDICARE: ENDOCRINOLOGY CONSULTS AND CARE SERVICE CORPORATION
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
1207RE0101XEndocrinology, Diabetes & Metabolism Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1F100165220OTHERILMEDICARE ID

General Provider Information

NPI Number : 1366843682
Entity Type Code : Organization
Provider Name (Legal Business Name) : ENDOCRINOLOGY CONSULTS AND CARE SERVICE CORPORATION
Provider Business Mailing Address
First Line : 1135 RIDGE RD
Second Line :
City : WILMETTE
State : IL
Zip : 60091-1567
Country : US
Telephone Number : 847-906-4910
Fax Number :
Provider Business Practice Location Address
First Line : 3048 W PETERSON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60659-3720
Country : US
Telephone Number : 773-381-0517
Fax Number : 773-381-0617
Authorized Official
Title or Position : PRESIDENT
Name : DR. SUSAN SHAPIRO BRAITHWAITE
Credential : M.D.
Telephone Number : 847-906-4910
Provider Enumeration Date : 09/05/2014
Last Update Date : 03/01/2016

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Directions to “ENDOCRINOLOGY CONSULTS AND CARE SERVICE CORPORATION ” Practice Location

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