MEDICARE: NORTH SHORE MRI CENTRE

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	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1616983	OTHER	IL	BC/BS OF ILLINOIS

General Provider Information

NPI Number	:	1508859349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH SHORE MRI CENTRE

Provider Business Mailing Address
First Line	:	9600 GROSS POINT RD
Second Line	:	SUITE A
City	:	SKOKIE
State	:	IL
Zip	:	60076-1214
Country	:	US
Telephone Number	:	847-933-3586
Fax Number	:	847-677-9625

Provider Business Practice Location Address
First Line	:	9600 GROSS POINT RD
Second Line	:	SUITE A
City	:	SKOKIE
State	:	IL
Zip	:	60076-1214
Country	:	US
Telephone Number	:	847-933-3586
Fax Number	:	847-677-9625

Authorized Official
Title or Position	:	ACCOUNTS RECEIVABLE SUPERVISOR
Name	:	MS. DAWN M PFLAUMER
Credential	:
Telephone Number	:	847-933-3586

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	08/22/2020

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Directions to “NORTH SHORE MRI CENTRE ” Practice Location

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