Provider Demographics
NPI:1962655118
Name:LIFESTAR MEDICAR
Entity Type:Organization
Organization Name:LIFESTAR MEDICAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-267-6020
Mailing Address - Street 1:2308 POETS LN
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-6650
Mailing Address - Country:US
Mailing Address - Phone:708-267-6020
Mailing Address - Fax:
Practice Address - Street 1:2308 POETS LN
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-6650
Practice Address - Country:US
Practice Address - Phone:708-267-6020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-01
Last Update Date:2008-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILN62272059076343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid