Organization
SURGEONS OF LAKE COUNTY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT CHRISTOPHER OTTO M.D. (PRESIDENT)
(847) 816-7495
Entity
Organization
Contact information
Practice address
1870 W WINCHESTER RD, SUITE 112, LIBERTYVILLE, IL 60048-5358
(847) 816-7495
(847) 816-7497
Mailing address
1870 W WINCHESTER RD, SUITE 112, LIBERTYVILLE, IL 60048-5358
(847) 816-7495
(847) 816-7497
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036109065
IL
Other
Enumeration date
10/04/2007
Last updated
10/01/2009
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