MEDICARE: NORTH SHORE INTERNAL MEDICINE

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	207R00000X	Internal Medicine Physician	03608577	IL

General Provider Information

NPI Number	:	1538281159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH SHORE INTERNAL MEDICINE

Provider Business Mailing Address
First Line	:	1430 N ARLINGTON HEIGHTS ROAD
Second Line	:	SUITE 105
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-4823
Country	:	US
Telephone Number	:	847-259-8226
Fax Number	:	847-392-5260

Provider Business Practice Location Address
First Line	:	1430 N ARLINGTON HEIGHTS ROAD
Second Line	:	SUITE 105
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-4823
Country	:	US
Telephone Number	:	847-259-8226
Fax Number	:	847-392-5260

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DEAN T VELIS
Credential	:	M.D.
Telephone Number	:	773-763-3808

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	11/20/2012

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Directions to “NORTH SHORE INTERNAL MEDICINE ” Practice Location

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