| Organization Name: | FAMILY PRACTICE SPECIALIST SC |
| NPI Number: | 1740470715 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICHARD J FEROLO (PRESIDENT) |
| Mailing Address: | 22285 Pepper Road Suite 211 Lake Barrington |
| State: | IL US |
| Postal Code: | 600100302 |
| Phone Number: | 8472779700 |
| Fax Number: | 8472779708 |
| NPI Enumeration Date: | 07/26/2007 |
| NPI Last Update Date: | 12/14/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |