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General NPI Number Information
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NPI Number | 1124272547
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Entity Type | Organization
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Legal Business Name | ADVOCATE CONDELL MEDICAL CENTER
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Dates
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Enumeration Date | 11/12/2008
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 801 S MILWAUKEE AVE
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-3204
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Country | US
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Telephone | 847-362-2900
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Fax | 847-573-4304
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Provider Business Mailing Address
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Address Line | 900 GARFIELD AVE
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-3141
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Country | US
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Telephone | 847-362-2900
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Fax | 847-573-4304
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Authorized Official
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Title or Position | VP MANAGED HEALTH
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Name | KARA RICHARDSON
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Credential |
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Telephone | 704-631-0450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 0000422
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License Number State | IL
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