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General NPI Number Information
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NPI Number | 1497935027
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Entity Type | Organization
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Legal Business Name | DEERFIELD HEALTHWORKS S C
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Dates
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Enumeration Date | 11/12/2007
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Last Update Date | 04/08/2011
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Provider Practice Location Address
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Address Line | 2525 WAUKEGAN RD
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City | BANNOCKBURN
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State | IL
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Zip | 60015-5514
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Country | US
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Telephone | 847-940-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 2525 WAUKEGAN RD
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City | BANNOCKBURN
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State | IL
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Zip | 60015-5514
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Country | US
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Telephone | 847-940-3800
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Fax |
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Authorized Official
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Title or Position | DO
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Name | DR. BERNARD LAKEMAKER
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Credential | DO
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Telephone | 847-590-1500
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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 | 036089110
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License Number State | IL
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