Provider Demographics
NPI:1285760546
Name:MEDICAL CARE OF NORTH CHICAGO, LTD
Entity type:Organization
Organization Name:MEDICAL CARE OF NORTH CHICAGO, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUBOV
Authorized Official - Middle Name:A
Authorized Official - Last Name:KLEMINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-744-7712
Mailing Address - Street 1:1800 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-5004
Mailing Address - Country:US
Mailing Address - Phone:773-744-7712
Mailing Address - Fax:773-395-8400
Practice Address - Street 1:2222 W DIVISION ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2717
Practice Address - Country:US
Practice Address - Phone:773-744-7712
Practice Address - Fax:773-395-8400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105632Medicaid
ILH56829Medicare UPIN
IL210130Medicare PIN