Provider Demographics
NPI:1356589345
Name:JOHN A LAVACCARE MD SC
Entity type:Organization
Organization Name:JOHN A LAVACCARE MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVACCARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-939-5169
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-0419
Mailing Address - Country:US
Mailing Address - Phone:847-939-5169
Mailing Address - Fax:847-939-5169
Practice Address - Street 1:1555 BARRINGTON RD
Practice Address - Street 2:205
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1019
Practice Address - Country:US
Practice Address - Phone:847-939-5169
Practice Address - Fax:847-939-5169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360998232084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty