Provider Demographics
NPI:1003959602
Name:LINCOLN MEDICAL ASSOCIATES,S.C.
Entity Type:Organization
Organization Name:LINCOLN MEDICAL ASSOCIATES,S.C.
Other - Org Name:MOLLOHAN MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:MOLLOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:630-548-5936
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:EOLA
Mailing Address - State:IL
Mailing Address - Zip Code:60519-0245
Mailing Address - Country:US
Mailing Address - Phone:630-548-5936
Mailing Address - Fax:630-548-5940
Practice Address - Street 1:535 FAIRWAY DR
Practice Address - Street 2:SUITE 107
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3938
Practice Address - Country:US
Practice Address - Phone:630-548-5936
Practice Address - Fax:630-548-5940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty