Organization
FAMILY MEDICINE ASSOCIATES OF LUTHERAN GENERAL S C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBROAH GEISMAR M.D. (PRESIDENT)
(847) 967-9660
Entity
Organization
Contact information
Practice address
7900 N MILWAUKEE AVE, SUITE 233, NILES, IL 60714-3159
(847) 967-9660
(847) 470-9323
Mailing address
7900 N MILWAUKEE AVE, SUITE 233, NILES, IL 60714-3159
(847) 967-9660
(847) 470-9323
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036073437
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01623792
BLUE CROSS BLUE SHIELD
IL
05
—
036073437
—
IL
Enumeration date
10/28/2006
Last updated
06/18/2008
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