Provider Demographics
NPI:1720185911
Name:LAKE COUNTY ACUTE CARE, LLP
Entity Type:Organization
Organization Name:LAKE COUNTY ACUTE CARE, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLP MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-253-5358
Mailing Address - Street 1:75 REMIT DRIVE
Mailing Address - Street 2:SUITE 1218
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-1218
Mailing Address - Country:US
Mailing Address - Phone:800-701-3381
Mailing Address - Fax:239-939-1682
Practice Address - Street 1:150 W HALF DAY RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6591
Practice Address - Country:US
Practice Address - Phone:847-215-0000
Practice Address - Fax:847-913-6947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214628Medicare PIN