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General NPI Number Information
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NPI Number | 1417093808
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Entity Type | Organization
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Legal Business Name | OB-GYNE ASSOCIATES OF LAKE FOREST, LTD.
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 959 S. WAUKEGAN RD FLOOR 2
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City | LAKE FOREST
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State | IL
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Zip | 60045
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Country | US
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Telephone | 847-234-3250
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Fax | 847-234-8155
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Provider Business Mailing Address
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Address Line | 959 S. WAUKESAN RD FLOOR 2
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City | LAKE FOREST
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State | IL
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Zip | 60045
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Country | US
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Telephone | 847-234-3250
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Fax | 847-234-8155
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL J HUBBELL
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Credential | M.D.
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Telephone | 847-234-3250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 042001387 036084828
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License Number State | IL
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