Provider Demographics
NPI:1861485658
Name:FAMILY CARE OF LAKE COUNTY S.C.
Entity Type:Organization
Organization Name:FAMILY CARE OF LAKE COUNTY S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:POMERANETS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-245-8700
Mailing Address - Street 1:500 PARK AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-6556
Mailing Address - Country:US
Mailing Address - Phone:847-245-8700
Mailing Address - Fax:847-245-8771
Practice Address - Street 1:500 PARK AVE
Practice Address - Street 2:STE 104
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-6556
Practice Address - Country:US
Practice Address - Phone:847-245-8700
Practice Address - Fax:847-245-8771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208919Medicare ID - Type Unspecified