MEDICARE: CRYSTAL LAKE IMMEDIATE CARE PHYSICIANS LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538517198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRYSTAL LAKE IMMEDIATE CARE PHYSICIANS LTD.

Provider Business Mailing Address
First Line	:	PO BOX 920128
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75392-0128
Country	:	US
Telephone Number	:	815-479-7490
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 E CONGRESS PKWY
Second Line	:	SUITE 100
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-6245
Country	:	US
Telephone Number	:	815-479-7490
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK THOMPSON
Credential	:	M.D.
Telephone Number	:	815-479-7490

Provider Enumeration Date	:	05/24/2016
Last Update Date	:	08/06/2025

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Directions to “CRYSTAL LAKE IMMEDIATE CARE PHYSICIANS LTD. ” Practice Location

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