Provider Demographics
NPI:1851432157
Name:LAKE COUNTY HEAD AND NECK SPECIALISTS S.C.
Entity Type:Organization
Organization Name:LAKE COUNTY HEAD AND NECK SPECIALISTS S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NERIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-662-4442
Mailing Address - Street 1:222 S GREENLEAF ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5705
Mailing Address - Country:US
Mailing Address - Phone:847-662-4442
Mailing Address - Fax:847-662-4446
Practice Address - Street 1:222 S GREENLEAF ST
Practice Address - Street 2:SUITE 106
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5705
Practice Address - Country:US
Practice Address - Phone:847-662-4442
Practice Address - Fax:847-662-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID NUMBER