Provider Demographics
NPI:1760544514
Name:LAKE COUNTY PHYSICIANS ASSOCIATION
Entity Type:Organization
Organization Name:LAKE COUNTY PHYSICIANS ASSOCIATION
Other - Org Name:SAINT THERESE PHYSICIANS ASSOCIATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LIBERATORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-360-2445
Mailing Address - Street 1:2615 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085
Mailing Address - Country:US
Mailing Address - Phone:847-360-2475
Mailing Address - Fax:847-625-6225
Practice Address - Street 1:2615 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085
Practice Address - Country:US
Practice Address - Phone:847-360-2475
Practice Address - Fax:847-625-6225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty