Organization Name: | LAKE COUNTY PAIN MANAGEMENT, LTD |
NPI Number: | 1023083656 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | STEVEN MARQUARDT (PRESIDENT) |
Mailing Address: | 1880 W Winchester Rd 101 Libertyville |
State: | IL US |
Postal Code: | 600485321 |
Phone Number: | 8472819543 |
Fax Number: | 8472819615 |
NPI Enumeration Date: | 02/17/2006 |
NPI Last Update Date: | 02/05/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP3300X |
License Number: | 036070591 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Pain |
Taxonomy Definition: |