Provider Demographics
NPI:1558315747
Name:ASSOCIATE S IN GASTROENTEROLOGY & LIVER DISEASE , LLC
Entity Type:Organization
Organization Name:ASSOCIATE S IN GASTROENTEROLOGY & LIVER DISEASE , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:FRADKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-295-1300
Mailing Address - Street 1:800 N WESTMORELAND RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1673
Mailing Address - Country:US
Mailing Address - Phone:847-295-1300
Mailing Address - Fax:847-295-1574
Practice Address - Street 1:800 N WESTMORELAND RD
Practice Address - Street 2:SUITE 102
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1673
Practice Address - Country:US
Practice Address - Phone:847-295-1300
Practice Address - Fax:847-295-1574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04929961OtherBLUE SHIELD
IL04929961OtherBLUE SHIELD