Healthcare Provider Details

I. General information

NPI: 1518145176
Provider Name (Legal Business Name): INTERVENTION ARMS MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 SHERIDAN RD
NORTH CHICAGO IL
60064-2235
US

IV. Provider business mailing address

1809 SHERIDAN RD
NORTH CHICAGO IL
60064-2235
US

V. Phone/Fax

Practice location:
  • Phone: 847-785-0611
  • Fax: 847-785-0617
Mailing address:
  • Phone: 847-785-0611
  • Fax: 847-785-0617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA ANN CHARLES FIELDS
Title or Position: DIRECTOR
Credential:
Phone: 847-785-0611