# LAKE IMMEDIATE CARE & CLINIC S C

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114208642
- **Authorized official:** DR. EBERECHUKWU IBE M.D (PRESIDENT)
- **Authorized official phone:** (708) 606-7219

## Contact information

- **Practice address:** 452 W STATE RD STE D, ISLAND LAKE, IL 60042-8438
- **Practice address phone:** (847) 519-1061
- **Mailing address:** 452 W STATE RD STE D, ISLAND LAKE, IL 60042-8438
- **Mailing address phone:** (847) 519-1061

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 036113328 | IL | — |
| 207R00000X | Internal Medicine Physician | 036107391 | IL | Yes |

## Other

- **Enumeration date:** 08/29/2011
- **Last updated:** 10/27/2011