Provider Demographics
NPI:1053485508
Name:LAMBRUSCHI, PHILIP G (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:G
Last Name:LAMBRUSCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-2248
Mailing Address - Country:US
Mailing Address - Phone:847-836-3200
Mailing Address - Fax:847-836-3204
Practice Address - Street 1:350 S 8TH ST
Practice Address - Street 2:
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-2248
Practice Address - Country:US
Practice Address - Phone:847-836-3200
Practice Address - Fax:847-836-3204
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-065955173000000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360659551Medicaid
IL0360659551Medicaid
ILP08062Medicare ID - Type Unspecified