North Shore University Health System

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

125057831 Issued in IL

Legal business name

NORTH SHORE UNIVERSITY HEALTH SYSTEM

Practice address

2650 Ridge Ave
Evanston, IL 60201-1718

Phone

(847) 570-2509

NPI assigned

Oct 11, 2011

Last updated

Oct 11, 2011By the provider in NPPES

Organization subpart

Yes

Parent organization

UNIVERSITY OF CHICAGO PRITZKER SCHOOL OF MEDICINEAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Liza Icayan, MDNPI 1316922529

Title

Program Director

Phone

(847) 570-2509

Specialties & licenses 1

Addresses

Part of

North Shore University Health System

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Liza Gaye Icayan, M.D.

  • Internal Medicine Physician
  • Evanston, IL
  • NPI 1316922529
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1318291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318291200000",
    "number": "1508141441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9744 DEE RD",
            "address_2": "APT # 402",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600161768",
            "telephone_number": "630-842-0067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011718",
            "telephone_number": "847-570-2509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE UNIVERSITY HEALTH SYSTEM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UNIVERSITY OF CHICAGO PRITZKER SCHOOL OF MEDICINE",
        "enumeration_date": "2011-10-11",
        "last_updated": "2011-10-11",
        "status": "A",
        "authorized_official_last_name": "ICAYAN",
        "authorized_official_first_name": "LIZA",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "847-570-2509",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125057831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• North Shore Physicians Group, LLC
• North Shore Physicians Group, LLC
• North Shore Resilient Family LLC
• North Shore Spinal Rehabilitation Center
• North Shore Therapy PLLC
• North Shore University Healthsystems Evanston Hospital
• North Star Counseling and Healing PLLC (North Sky Psychotherapy)
• North Star Psychotherapy PLLC
• North Suburban Cardiology Associates, S.C.
• North Suburban Cardiology Group, LTD

• Internal Medicine Physician in Evanston, IL
• Providers in Evanston, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.