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NPI Code Detail

MEDICARE: CONDELL MEDICAL CENTER

MEDICARE: CONDELL MEDICAL CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1282N00000XGeneral Acute Care Hospital0000422IL

General Provider Information

NPI Number : 1043213911
Entity Type Code : Organization
Provider Name (Legal Business Name) : CONDELL MEDICAL CENTER
Provider Business Mailing Address
First Line : 900 GARFIELD AVE
Second Line :
City : LIBERTYVILLE
State : IL
Zip : 60048-3141
Country : US
Telephone Number : 847-362-2900
Fax Number : 847-573-4304
Provider Business Practice Location Address
First Line : 801 S MILWAUKEE AVE
Second Line :
City : LIBERTYVILLE
State : IL
Zip : 60048-3199
Country : US
Telephone Number : 847-362-2900
Fax Number : 847-573-4304
Authorized Official
Title or Position : EXECUTIVE VICE PRESIDENT
Name : MR. ANDREW STEFO
Credential :
Telephone Number : 847-990-5202
Provider Enumeration Date : 05/24/2005
Last Update Date : 04/20/2008

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Directions to “CONDELL MEDICAL CENTER ” Practice Location

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