1114068293 NPI number — NORTHSHORE HEALTH PARTNERS LTD

Table of content: DR. STEVEN CHARLES GRIBAR M.D. (NPI 1184826091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114068293 NPI number — NORTHSHORE HEALTH PARTNERS LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHSHORE HEALTH PARTNERS LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114068293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5140 N CALIFORNIA AVE
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60625-3645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-878-3326
Provider Business Mailing Address Fax Number:
773-878-3614

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5140 N CALIFORNIA AVE
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60625-3645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-878-3326
Provider Business Practice Location Address Fax Number:
773-878-3614
Provider Enumeration Date:
02/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SURUCCI
Authorized Official First Name:
ARMINIO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
773-878-3326

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110208482 . This is a "RR MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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