Organization
LAKE NORTH INSTITUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDER GORODETSKY M.D (PHYSICIAN)
(847) 298-2200
Entity
Organization
Contact information
Practice address
1247 MILWAUKEE AVE, GLENVIEW, IL 60025-2464
(847) 298-2200
(847) 298-2299
Mailing address
67 BEACH RD, GLENCOE, IL 60022-1313
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036096374
IL
Other
Enumeration date
06/28/2011
Last updated
09/01/2011
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