Organization
LAKE CICERO CLINIC, S.C.
Active
Other names
Lake Cicero Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GURCHARAN SINGH RANDHAWA M.D. (OWNER - PHYSICIAN)
(773) 378-8100
Entity
Organization
Contact information
Practice address
4801 W LAKE ST, CHICAGO, IL 60644-2609
(773) 378-8100
Mailing address
4801 W LAKE ST, CHICAGO, IL 60644-2609
(773) 378-8100
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036085519
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1639206535
INDIVIDUAL NPI
IL
Enumeration date
09/10/2012
Last updated
09/10/2012
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