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General NPI Number Information
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NPI Number | 1821137183
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Entity Type | Organization
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Legal Business Name | VCFE OF LAKE COUNTY, INC
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1445 N HUNT CLUB RD SUITE 103
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City | GURNEE
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State | IL
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Zip | 60031-2603
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Country | US
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Telephone | 847-856-2534
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Fax | 847-856-2534
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Provider Business Mailing Address
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Address Line | 1445 N HUNT CLUB RD SUITE 103
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City | GURNEE
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State | IL
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Zip | 60031-2603
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Country | US
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Telephone | 847-856-2534
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Fax | 847-856-2534
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIMOTHY RYAN
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Credential | MD
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Telephone | 847-856-2534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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