| Organization Name: | ROUND LAKE MEDICAL SUITES |
| NPI Number: | 1861513822 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SUSAN GOODMAN (OFFICE MANAGER) |
| Mailing Address: | 2 E Rollins Rd Suite 108 Round Lake Beach |
| State: | IL US |
| Postal Code: | 600733808 |
| Phone Number: | 8475469455 |
| Fax Number: | 8472472840 |
| NPI Enumeration Date: | 04/03/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0800X |
| License Number: | 42618258 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Endoscopy |
| Taxonomy Definition: | |