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General NPI Number Information
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NPI Number | 1285760546
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Entity Type | Organization
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Legal Business Name | MEDICAL CARE OF NORTH CHICAGO, LTD
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 02/10/2015
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Provider Practice Location Address
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Address Line | 2222 W DIVISION ST SUITE 200
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City | CHICAGO
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State | IL
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Zip | 60622-2717
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Country | US
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Telephone | 773-744-7712
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Fax | 773-395-8400
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Provider Business Mailing Address
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Address Line | 1800 HARRISON ST
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City | GLENVIEW
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State | IL
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Zip | 60025-5004
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Country | US
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Telephone | 773-744-7712
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Fax | 773-395-8400
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LUBOV A KLEMINE
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Credential | M.D.
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Telephone | 773-744-7712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036105632
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License Number State | IL
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