Provider Demographics
NPI:1588666150
Name:LAKE COUNTY MEDICAL GROUP SC
Entity Type:Organization
Organization Name:LAKE COUNTY MEDICAL GROUP SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-566-0300
Mailing Address - Street 1:157 N SEYMOUR AVE
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-2304
Mailing Address - Country:US
Mailing Address - Phone:847-566-0300
Mailing Address - Fax:847-566-2818
Practice Address - Street 1:157 N SEYMOUR AVE
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-2304
Practice Address - Country:US
Practice Address - Phone:847-566-0300
Practice Address - Fax:847-566-2818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty