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General NPI Number Information
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NPI Number | 1801897434
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Entity Type | Organization
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Legal Business Name | LAKE COOK SURGICAL ASSOCIATES PC
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Dates
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Enumeration Date | 08/04/2005
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Last Update Date | 07/16/2007
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Provider Practice Location Address
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Address Line | 1600 DEMPSTER ST SUITE 102
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City | PARK RIDGE
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State | IL
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Zip | 60068-1109
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Country | US
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Telephone | 847-635-9006
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Fax |
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Provider Business Mailing Address
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Address Line | 520 E 22ND ST
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City | LOMBARD
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State | IL
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Zip | 60148-6110
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Country | US
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Telephone | 630-874-2542
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JANICE R. KLICH
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Credential | M.D.
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Telephone | 847-635-9006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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