| North Suburban Health Care Ltd | |
|
1870 W Winchester Rd Suite 248 Libertyville IL 60048-5358 | |
| (847) 913-9434 | |
| (847) 913-9432 |
| Full Name | North Suburban Health Care Ltd |
|---|---|
| Speciality | Internal Medicine |
| Location | 1870 W Winchester Rd, Libertyville, Illinois |
| Authorized Official Name and Position | Mohina Gupta (OWNER) |
| Authorized Official Contact | 8479139434 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| North Suburban Health Care Ltd 1870 W Winchester Rd Suite 248 Libertyville IL 60048-5358 Ph: (847) 913-9434 | North Suburban Health Care Ltd 1870 W Winchester Rd Suite 248 Libertyville IL 60048-5358 Ph: (847) 913-9434 |
| NPI Number | 1235353871 |
|---|---|
| Provider Enumeration Date | 04/13/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 7416056361 |
|---|---|
| Medicare Enrollment ID | O20070619000246 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235353871 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Illinois) | Primary |
| Provider Name | Mohina Gupta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174578843 PECOS PAC ID: 1052410990 Enrollment ID: I20070619000241 |
| Provider Name | Jennifer J Rogulic |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457881682 PECOS PAC ID: 7810263068 Enrollment ID: I20171017000027 |
| Provider Name | Corrin Miranda |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306370838 PECOS PAC ID: 5698039162 Enrollment ID: I20190619000484 |
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