Organization
LAKE IMMEDIATE CARE & CLINIC S C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EBERECHUKWU IBE M.D (PRESIDENT)
(708) 606-7219
Entity
Organization
Contact information
Practice address
452 W STATE RD STE D, ISLAND LAKE, IL 60042-8438
(847) 519-1061
Mailing address
452 W STATE RD STE D, ISLAND LAKE, IL 60042-8438
(847) 519-1061
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036113328
IL
207R00000X
Internal Medicine Physician
Primary
036107391
IL
Other
Enumeration date
08/29/2011
Last updated
10/27/2011
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