Provider Demographics
NPI:1760694152
Name:LAKE ZURICH MEDICAL ASSOCIATES LTD
Entity Type:Organization
Organization Name:LAKE ZURICH MEDICAL ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:847-438-2454
Mailing Address - Street 1:290 N RAND RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2213
Mailing Address - Country:US
Mailing Address - Phone:847-438-2454
Mailing Address - Fax:847-438-2462
Practice Address - Street 1:290 N RAND RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2213
Practice Address - Country:US
Practice Address - Phone:847-438-2454
Practice Address - Fax:847-438-2462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-05
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL675160Medicare PIN
IL996470Medicare PIN
ILD14681Medicare UPIN
ILH24230Medicare UPIN