Provider Demographics
NPI:1366843682
Name:ENDOCRINOLOGY CONSULTS AND CARE SERVICE CORPORATION
Entity type:Organization
Organization Name:ENDOCRINOLOGY CONSULTS AND CARE SERVICE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:SHAPIRO
Authorized Official - Last Name:BRAITHWAITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-906-4910
Mailing Address - Street 1:1135 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1567
Mailing Address - Country:US
Mailing Address - Phone:847-906-4910
Mailing Address - Fax:
Practice Address - Street 1:3048 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3720
Practice Address - Country:US
Practice Address - Phone:773-381-0517
Practice Address - Fax:773-381-0617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF100165220OtherMEDICARE ID