Organization
LAKE SHORE GASTROENTEROLGY SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE L. MCKERLIE (ADMINISTRATOR)
(847) 244-2960
Entity
Organization
Contact information
Practice address
20 TOWER CT, SUITE C, GURNEE, IL 60031
(847) 244-6320
(847) 244-5095
Mailing address
20 TOWER CT, SUITE C, GURNEE, IL 60031
(847) 244-6320
(847) 244-5095
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
—
—
Other
Enumeration date
02/26/2007
Last updated
09/08/2008
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