Organization
TAKECARE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA SULLIVAN APN (MARKET MANAGER)
(224) 500-7627
Entity
Organization
Contact information
Practice address
305 W ROLLINS RD, ROUND LAKE BEACH, IL 60073-1217
(224) 338-3567
(847) 546-3089
Mailing address
305 W ROLLINS RD, ROUND LAKE BEACH, IL 60073-1217
(224) 338-3567
(847) 546-3089
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
209008821
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720373731
—
IL
Enumeration date
03/30/2015
Last updated
03/30/2015
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