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General NPI Number Information
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NPI Number | 1285048975
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Entity Type | Organization
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Legal Business Name | LAKE COUNTY IMMEDIATE CARE, LLC
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Dates
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Enumeration Date | 06/20/2014
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Last Update Date | 06/20/2014
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Provider Practice Location Address
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Address Line | 724 N GREEN BAY RD
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City | WAUKEGAN
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State | IL
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Zip | 60085-2236
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Country | US
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Telephone | 312-753-5167
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Fax |
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Provider Business Mailing Address
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Address Line | 65 E MONROE ST SUITE 4726
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City | CHICAGO
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State | IL
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Zip | 60603-5717
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Country | US
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Telephone | 312-753-5167
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JOHN V. JURICA
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Credential | M.D.
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Telephone | 815-263-3486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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