Provider Demographics
NPI:1740690494
Name:LG CARE PC
Entity type:Organization
Organization Name:LG CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:
Authorized Official - Last Name:GURVICH
Authorized Official - Suffix:
Authorized Official - Credentials:ANP,MS, CWS
Authorized Official - Phone:847-293-7375
Mailing Address - Street 1:1910 LANDWEHR RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-5163
Mailing Address - Country:US
Mailing Address - Phone:847-293-7375
Mailing Address - Fax:847-400-0881
Practice Address - Street 1:1910 LANDWEHR RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-5163
Practice Address - Country:US
Practice Address - Phone:847-293-7375
Practice Address - Fax:847-400-0881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-03
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.006769363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL331022542001Medicaid
IL 2978Medicare PIN
ILIL 3753Medicare PIN