Provider Demographics
NPI:1942498209
Name:NORTH SHERIDAN FAMILY MEDICINE PC
Entity type:Organization
Organization Name:NORTH SHERIDAN FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORELIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-432-7830
Mailing Address - Street 1:396 TEMPLE AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-1435
Mailing Address - Country:US
Mailing Address - Phone:847-432-7830
Mailing Address - Fax:847-432-7966
Practice Address - Street 1:396 TEMPLE AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-1435
Practice Address - Country:US
Practice Address - Phone:847-432-7830
Practice Address - Fax:847-432-7966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
IL036071566174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036071566Medicaid
IL1881794592OtherBC/BS IL
IL351070Medicare PIN