Organization
LAKE COUNTY PHYSICIANS ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTORIA L WELTER (DIRECTOR FULL SERVICE UNIT)
(815) 490-6752
Entity
Organization
Contact information
Practice address
630 E JEFFERSON ST, ROCKFORD, IL 61107-4026
(815) 490-6752
Mailing address
630 E JEFFERSON ST, ROCKFORD, IL 61107-4026
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Enumeration date
12/13/2006
Last updated
08/22/2020
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