Organization
ADVOCATE NORTH SIDE HEALTH NETWORK
Active
Parent organization
ADVOCATE NORTH SIDE HEALTH NETWORK
Other names
Advocate Illinois Masonic Physician Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
ADVOCATE NORTH SIDE HEALTH NETWORK
Authorized official
MR. IAN D STEWART (VP BUSINESS SYSTEMS, FINANCE, OPS.)
(847) 390-5453
Entity
Organization
Contact information
Practice address
836 W WELLINGTON AVE, CHICAGO, IL 60657-5147
(847) 390-5453
Mailing address
836 W WELLINGTON AVE, CHICAGO, IL 60657-5147
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB2697
RR MEDICARE
IL
Enumeration date
09/12/2006
Last updated
01/25/2013
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