Provider Demographics
NPI:1225122419
Name:THE LIBERTYVILLE SURGEONS, S C
Entity Type:Organization
Organization Name:THE LIBERTYVILLE SURGEONS, S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HABEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-367-1800
Mailing Address - Street 1:890 GARFIELD AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-4723
Mailing Address - Country:US
Mailing Address - Phone:847-367-1800
Mailing Address - Fax:847-367-1825
Practice Address - Street 1:890 GARFIELD AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-4723
Practice Address - Country:US
Practice Address - Phone:847-367-1800
Practice Address - Fax:847-367-1825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1447265871OtherNPI WILLIAM WATSON MD
ILH91223Medicare UPIN
ILD15746Medicare UPIN