Organization
LAKE COUNTY ANESTHESIOLOGISTS LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN MARQUARDT MD (PRESIDENT)
(847) 362-2905
Entity
Organization
Contact information
Practice address
801 S MILWAUKEE AVE, LIBERTYVILLE, IL 60048-3204
(847) 362-2905
Mailing address
PO BOX 70, LAKE FOREST, IL 60045-0070
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
42003024
IL
367500000X
Certified Registered Nurse Anesthetist
42003024
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04915047
BLUE CROSS BLUE SHIELD
IL
Enumeration date
05/28/2006
Last updated
10/29/2007
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