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General NPI Number Information
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NPI Number | 1932183365
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Entity Type | Organization
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Legal Business Name | LAKE FOREST MEDICAL SC
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 05/12/2009
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Provider Practice Location Address
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Address Line | 800 N WESTMORELAND RD SUITE 100
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City | LAKE FOREST
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State | IL
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Zip | 60045-1673
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Country | US
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Telephone | 847-604-8144
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Fax | 847-234-4682
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Provider Business Mailing Address
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Address Line | 800 N WESTMORELAND RD SUITE 100
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City | LAKE FOREST
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State | IL
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Zip | 60045-1673
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Country | US
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Telephone | 847-604-8144
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Fax | 847-234-4682
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SCOTT E BRAUNLICH
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Credential | M.D.
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Telephone | 847-604-8144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 042618006
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License Number State | IL
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