Organization
LIFE MEDICAL SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOANNA E LESZCZAK RN (PRACTICE MANAGER)
(847) 653-8413
Entity
Organization
Contact information
Practice address
1550 N NORTHWEST HWY, SUITE 209, PARK RIDGE, IL 60068-1411
(847) 653-8413
(847) 292-0850
Mailing address
1550 N NORTHWEST HWY, SUITE 209, PARK RIDGE, IL 60068-1411
(847) 653-8413
(847) 292-0850
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
042.618530
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042.618530
LICENCE
IL
Enumeration date
03/09/2007
Last updated
12/26/2012
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