Organization
ASSOCIATE S IN GASTROENTEROLOGY & LIVER DISEASE , LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAT FRADKIN (OFFICE MANAGER)
(847) 295-1300
Entity
Organization
Contact information
Practice address
800 N WESTMORELAND RD, SUITE 102, LAKE FOREST, IL 60045-1673
(847) 295-1300
(847) 295-1574
Mailing address
800 N WESTMORELAND RD, SUITE 102, LAKE FOREST, IL 60045-1673
(847) 295-1300
(847) 295-1574
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04929961
BLUE SHIELD
IL
Enumeration date
05/20/2006
Last updated
08/22/2020
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