Provider Demographics
NPI:1528193414
Name:LAKE COOK NEUROLOGICAL CONSULTANTS, S.C
Entity Type:Organization
Organization Name:LAKE COOK NEUROLOGICAL CONSULTANTS, S.C
Other - Org Name:LUTHERAN GENERAL NEUROLOGY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:WASSERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-298-4590
Mailing Address - Street 1:8780 W GOLF RD
Mailing Address - Street 2:#202
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714
Mailing Address - Country:US
Mailing Address - Phone:847-298-4590
Mailing Address - Fax:847-298-0635
Practice Address - Street 1:8780 W GOLF RD
Practice Address - Street 2:SUITE 202
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714
Practice Address - Country:US
Practice Address - Phone:847-298-4590
Practice Address - Fax:847-298-0635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D12194Medicare UPIN
740140Medicare ID - Type Unspecified