MEDICARE: NORTHSHORE ORAL SURGERY CENTER

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1952095010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHSHORE ORAL SURGERY CENTER

Provider Business Mailing Address
First Line	:	2300 S MICHIGAN AVE STE 100
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2119
Country	:	US
Telephone Number	:	872-302-5322
Fax Number	:	872-282-0337

Provider Business Practice Location Address
First Line	:	2300 S MICHIGAN AVE STE 100
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2119
Country	:	US
Telephone Number	:	773-255-1128
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL ANTHONY GUTHRIE
Credential	:	DDS
Telephone Number	:	773-255-1128

Provider Enumeration Date	:	06/02/2023
Last Update Date	:	09/08/2025

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