MEDICARE: LAKE ZURICH MEDICAL ASSOCIATES LTD

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
1	207R00000X	Internal Medicine Physician		IL

General Provider Information

NPI Number	:	1760694152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE ZURICH MEDICAL ASSOCIATES LTD

Provider Business Mailing Address
First Line	:	290 N RAND RD
Second Line	:	SUITE A
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-2213
Country	:	US
Telephone Number	:	847-438-2454
Fax Number	:	847-438-2462

Provider Business Practice Location Address
First Line	:	290 N RAND RD
Second Line	:	SUITE A
City	:	LAKE ZURICH
State	:	IL
Zip	:	60047-2213
Country	:	US
Telephone Number	:	847-438-2454
Fax Number	:	847-438-2462

Authorized Official
Title or Position	:	OWNER
Name	:	BARRY W BERGER
Credential	:	D.O.
Telephone Number	:	847-438-2454

Provider Enumeration Date	:	05/05/2007
Last Update Date	:	03/24/2008

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