Provider Demographics
NPI:1265090849
Name:LAKE COUNTY IMMEDIATE CARE, LLC
Entity type:Organization
Organization Name:LAKE COUNTY IMMEDIATE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:V
Authorized Official - Last Name:JURICA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-263-3486
Mailing Address - Street 1:65 E MONROE ST UNIT 4726
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-5755
Mailing Address - Country:US
Mailing Address - Phone:312-753-5167
Mailing Address - Fax:
Practice Address - Street 1:420 E IL ROUTE 173 STE 101
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-7284
Practice Address - Country:US
Practice Address - Phone:847-652-9700
Practice Address - Fax:847-652-9710
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROMPTMED URGENT CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care