Provider Demographics
NPI:1639163686
Name:LAKE COUNTY NEUROLOGICAL ASSOCIATES LTD
Entity type:Organization
Organization Name:LAKE COUNTY NEUROLOGICAL ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEESOOLAL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHHABRIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-249-3100
Mailing Address - Street 1:1616 GRAND AVE
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-3600
Mailing Address - Country:US
Mailing Address - Phone:847-249-3100
Mailing Address - Fax:847-249-3199
Practice Address - Street 1:1616 GRAND AVE
Practice Address - Street 2:SUITE # 103
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-3600
Practice Address - Country:US
Practice Address - Phone:847-249-3100
Practice Address - Fax:847-249-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2021-12-09
Deactivation Date:2008-04-08
Deactivation Code:
Reactivation Date:2008-08-26
Provider Licenses
StateLicense IDTaxonomies
IL0360528492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052849Medicaid
IL648730Medicare PIN
IL036052849Medicaid