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General NPI Number Information
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NPI Number | 1588666150
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Entity Type | Organization
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Legal Business Name | LAKE COUNTY MEDICAL GROUP SC
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Dates
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Enumeration Date | 08/12/2005
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Last Update Date | 06/18/2010
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Provider Practice Location Address
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Address Line | 157 N SEYMOUR AVE
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City | MUNDELEIN
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State | IL
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Zip | 60060-2304
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Country | US
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Telephone | 847-566-0300
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Fax | 847-566-2818
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Provider Business Mailing Address
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Address Line | 157 N SEYMOUR AVE
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City | MUNDELEIN
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State | IL
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Zip | 60060-2304
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Country | US
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Telephone | 847-566-0300
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Fax | 847-566-2818
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. NINA NEYMAN
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Credential | M.D.
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Telephone | 847-566-0300
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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 |
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License Number State |
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