Organization
SURGIACL ASSISTINGSERVICES OF LAKE COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KIM LADELL LUSTER (SURGICAL ASSISTANT)
12243999317
Entity
Organization
Contact information
Practice address
2400 N SAMSON WAY, APT#2D, WAUKEGAN, IL 60087-5079
(122) 439-9931
(224) 944-0084
Mailing address
2400 N SAMSON WAY, APT#2D, WAUKEGAN, IL 60087-5079
(122) 439-9931
(224) 944-0084
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
—
IL
Other
Enumeration date
02/22/2007
Last updated
08/22/2020
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