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General NPI Number Information
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NPI Number | 1265833958
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Entity Type | Organization
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Legal Business Name | LAKE COUNTY INTERNAL MEDICINE ASSOCIATION LLC
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Dates
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Enumeration Date | 09/12/2014
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Last Update Date | 09/12/2014
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Provider Practice Location Address
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Address Line | 5911 KILDEER CT
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City | LONG GROVE
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State | IL
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Zip | 60047-5052
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Country | US
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Telephone | 847-672-8373
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Fax | 815-464-9285
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Provider Business Mailing Address
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Address Line | 5911 KILDEER CT
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City | LONG GROVE
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State | IL
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Zip | 60047-5052
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Country | US
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Telephone | 847-672-8373
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Fax | 815-464-9285
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Authorized Official
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Title or Position | M.D.
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Name | DR. MARIUSZ MILEJCZYK
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Credential | M.D.
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Telephone | 847-596-7426
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number |
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License Number State |
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