Provider Demographics
NPI:1942491873
Name:LIMBERIS-NELSON MEDICAL GROUP, S.C.
Entity Type:Organization
Organization Name:LIMBERIS-NELSON MEDICAL GROUP, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-697-5144
Mailing Address - Street 1:87 N AIRLITE
Mailing Address - Street 2:#150
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123
Mailing Address - Country:US
Mailing Address - Phone:847-697-5144
Mailing Address - Fax:847-697-8024
Practice Address - Street 1:87 N AIRLITE
Practice Address - Street 2:#150
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123
Practice Address - Country:US
Practice Address - Phone:847-697-5144
Practice Address - Fax:847-697-8024
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIMBERIS-NELSON MEDICAL GROUP,S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-06
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036 091028207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36091028Medicaid
ILF95451Medicare UPIN
IL36091028Medicaid