Organization
NORTHLAKE MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GIRI RAO MD (OWNER)
(989) 225-6493
Entity
Organization
Contact information
Practice address
161 E NORTH AVE, NORTHLAKE, IL 60164-2523
(708) 450-5000
(708) 450-5055
Mailing address
161 E NORTH AVE, NORTHLAKE, IL 60164-2523
(708) 450-5000
(708) 450-5055
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
036070313
IL
Other
Enumeration date
07/06/2012
Last updated
07/17/2012
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