Provider Demographics
NPI:1376661199
Name:POPLAR CREEK FAMILY PRACTICE
Entity Type:Organization
Organization Name:POPLAR CREEK FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-882-2400
Mailing Address - Street 1:1555 BARRINGTON RD
Mailing Address - Street 2:SUITE 3450
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60194-1019
Mailing Address - Country:US
Mailing Address - Phone:847-882-2400
Mailing Address - Fax:847-884-7222
Practice Address - Street 1:1555 BARRINGTON RD
Practice Address - Street 2:SUITE 3450
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60194-1019
Practice Address - Country:US
Practice Address - Phone:847-882-2400
Practice Address - Fax:847-884-7222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL947670Medicare ID - Type Unspecified