# OB/GYNE ASSOCIATES OF LAKE COUNTY, S.C.

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

## Provider details

- **NPI number:** 1497748222
- **Authorized official:** DR. RICHARD MCCLOUD ALLEN M.D. (PHYSICIAN)
- **Authorized official phone:** (847) 549-1818

## Contact information

- **Practice address:** 890 GARFIELD AVE, SUITE 200, LIBERTYVILLE, IL 60048-4723
- **Practice address phone:** (847) 549-1818
- **Practice address fax:** (847) 680-1573
- **Mailing address:** 890 GARFIELD AVE, SUITE 200, LIBERTYVILLE, IL 60048-4723
- **Mailing address phone:** (847) 549-1818
- **Mailing address fax:** (847) 680-1573

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 036067062 | IL | Yes |

## Other

- **Enumeration date:** 08/26/2005
- **Last updated:** 07/31/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 036067062 | — | IL |