Healthcare Provider Details

I. General information

NPI: 1053485508
Provider Name (Legal Business Name): PHILIP G LAMBRUSCHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S 8TH ST
WEST DUNDEE IL
60118-2248
US

IV. Provider business mailing address

350 S 8TH ST
WEST DUNDEE IL
60118-2248
US

V. Phone/Fax

Practice location:
  • Phone: 847-836-3200
  • Fax: 847-836-3204
Mailing address:
  • Phone: 847-836-3200
  • Fax: 847-836-3204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number036-065955
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number036-065955
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: