Healthcare Provider Details

I. General information

NPI: 1427044759
Provider Name (Legal Business Name): ROUND LAKE FAMILY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 RAILROAD AVE
ROUND LAKE IL
60073-3237
US

IV. Provider business mailing address

707 RAILROAD AVE
ROUND LAKE IL
60073-3237
US

V. Phone/Fax

Practice location:
  • Phone: 847-546-8777
  • Fax: 847-546-8779
Mailing address:
  • Phone: 847-546-8777
  • Fax: 847-546-8779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAI JUNG NHO
Title or Position: GENERAL PARTNER
Credential: M.D.
Phone: 847-546-8777