Organization
ORTHOPEDIC CENTER OF LAKE COUNTY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERALD SAUL KANE M.D. (M.D./PRESIDENT)
(847) 433-3700
Entity
Organization
Contact information
Practice address
625 ROGER WILLIAMS AVE, SUITE 108, HIGHLAND PARK, IL 60035-4840
(847) 433-3700
(847) 433-1699
Mailing address
625 ROGER WILLIAMS AVE, SUITE 108, HIGHLAND PARK, IL 60035-4840
(847) 433-3700
(847) 433-1699
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036-035962
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036035962
—
IL
01
—
0363650001
ADMINISTAR
IL
01
—
04915292
BLUECROSS/BLUESHIELD
IL
01
—
202757512
RAILROAD MEDICARE
GA
01
—
483397
AETNA
IL
01
—
P12557
MEDICARE PIN
IL
Enumeration date
08/01/2006
Last updated
07/27/2007
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