Organization
PHYSICIANS OF THE NORTH SHORE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLY E. DIETRICH C.M.M. (PRACTICE MANAGER)
(847) 679-3411
Entity
Organization
Contact information
Practice address
9555 GROSS POINT ROAD, SKOKIE, IL 60077
(847) 679-3411
(847) 675-7450
Mailing address
9555 GROSS POINT ROAD, SKOKIE, IL 60077
(847) 679-3411
(847) 675-7450
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
20905900
IL
Other
Enumeration date
05/17/2007
Last updated
08/22/2020
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