Provider Demographics
NPI:1053367375
Name:NORTHSHORE UNIVERSITY HEALTHSYSTEM
Entity type:Organization
Organization Name:NORTHSHORE UNIVERSITY HEALTHSYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:WELDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-570-5099
Mailing Address - Street 1:1301 CENTRAL ST
Mailing Address - Street 2:RM 222
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1613
Mailing Address - Country:US
Mailing Address - Phone:847-570-5230
Mailing Address - Fax:847-570-5240
Practice Address - Street 1:2050 PFINGSTEN RD
Practice Address - Street 2:MEDICAL OFFICE BUILDING SOUTH - SUITE 100
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1324
Practice Address - Country:US
Practice Address - Phone:847-657-1785
Practice Address - Fax:847-657-1787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0003483333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0689530007Medicare NSC