Provider Demographics
NPI:1003973827
Name:UROLOGY SPECIALISTS OF LAKE COUNTY, S.C.
Entity Type:Organization
Organization Name:UROLOGY SPECIALISTS OF LAKE COUNTY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAZA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-599-1111
Mailing Address - Street 1:202 S GREENLEAF ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3399
Mailing Address - Country:US
Mailing Address - Phone:847-599-1111
Mailing Address - Fax:847-599-1148
Practice Address - Street 1:202 S GREENLEAF ST
Practice Address - Street 2:SUITE D
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3399
Practice Address - Country:US
Practice Address - Phone:847-599-1111
Practice Address - Fax:847-599-1148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty