Provider Demographics
NPI:1407803174
Name:HEAD & NECK ASSOCIATES, SC
Entity Type:Organization
Organization Name:HEAD & NECK ASSOCIATES, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:LERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-827-2300
Mailing Address - Street 1:1400 E GOLF RD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1236
Mailing Address - Country:US
Mailing Address - Phone:847-827-2300
Mailing Address - Fax:847-827-2392
Practice Address - Street 1:1400 E GOLF RD
Practice Address - Street 2:SUITE 121
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1236
Practice Address - Country:US
Practice Address - Phone:847-827-2300
Practice Address - Fax:847-827-2392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2009-06-24
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
IL=========OtherTAX ID NUMBER
IL213269Medicare PIN