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Organization
LAKE CICERO CLINIC, S.C.
Active
Organization
LAKE CICERO CLINIC, S.C.
Active
Other names
Lake Cicero Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GURCHARAN SINGH RANDHAWA M.D. (OWNER - PHYSICIAN)
(773) 378-8100
Entity
Organization
Contact information
Practice address
4801 W LAKE ST, CHICAGO, IL 60644-2609
(773) 378-8100
Mailing address
4801 W LAKE ST, CHICAGO, IL 60644-2609
(773) 378-8100
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036085519
IL
Other
Enumeration date
09/10/2012
Last updated
09/10/2012
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