# LAKE COUNTY PHYSICAL MEDICINE, S.C.

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

## Provider details

- **NPI number:** 1558799924
- **Authorized official:** JUSTIN ATKINSON D.C. (PRESIDENT)
- **Authorized official phone:** (847) 223-3158

## Contact information

- **Practice address:** 15 COMMERCE DR, 108, GRAYSLAKE, IL 60030-7807
- **Practice address phone:** (847) 223-3158
- **Mailing address:** 15 COMMERCE DR, 108, GRAYSLAKE, IL 60030-7807
- **Mailing address phone:** (847) 223-3158
- **Mailing address fax:** (888) 481-4758

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 036.042751 | IL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | 036.042751 | IL | Yes |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |
| 363L00000X | Nurse Practitioner | 209-009124 | IL | — |

## Other

- **Enumeration date:** 10/23/2013
- **Last updated:** 02/06/2014