Provider Demographics
NPI:1134394554
Name:LIVING WELL MEDICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:LIVING WELL MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BELSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-418-2030
Mailing Address - Street 1:1535 LAKE COOK RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1447
Mailing Address - Country:US
Mailing Address - Phone:847-418-2030
Mailing Address - Fax:847-564-5250
Practice Address - Street 1:1535 LAKE COOK RD
Practice Address - Street 2:SUITE 306
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1447
Practice Address - Country:US
Practice Address - Phone:847-418-2030
Practice Address - Fax:847-564-5250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-26
Last Update Date:2008-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107233207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty