Provider Demographics
NPI:1356680300
Name:INFECTIOUS DISEASE CONSULTANTS OF NORTHERN ILLINOIS S.C.
Entity Type:Organization
Organization Name:INFECTIOUS DISEASE CONSULTANTS OF NORTHERN ILLINOIS S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BABETTE
Authorized Official - Middle Name:S
Authorized Official - Last Name:TILDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-672-4940
Mailing Address - Street 1:1880 W WINCHESTER RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5341
Mailing Address - Country:US
Mailing Address - Phone:847-672-4940
Mailing Address - Fax:847-855-5277
Practice Address - Street 1:1880 W WINCHESTER RD
Practice Address - Street 2:SUITE 106
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5341
Practice Address - Country:US
Practice Address - Phone:847-672-4940
Practice Address - Fax:847-855-5277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-115915207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty