Organization
LAKE COUNTY INTERNAL MEDICINE ASSOCIATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIUSZ MILEJCZYK M.D. (M.D.)
(847) 596-7426
Entity
Organization
Contact information
Practice address
5911 KILDEER CT, LONG GROVE, IL 60047-5052
(847) 672-8373
(815) 464-9285
Mailing address
5911 KILDEER CT, LONG GROVE, IL 60047-5052
(847) 672-8373
(815) 464-9285
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DT3947
RAILROAD MEDICARE
IL
01
—
P01139269
RAILROAD MEDICARE INDIVIDUAL
IL
Enumeration date
09/12/2014
Last updated
09/12/2014
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