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Organization

ENT CONSULTANTS OF LAKE COUNTY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. STACEY M WILCOX (OFFICE MANAGER)
(847) 816-1228
Entity
Organization

Contact information

Practice address
755 S MILWAUKEE AVE, STE 181, LIBERTYVILLE, IL 60048-3253
(847) 816-1228
(847) 816-1262
Mailing address
755 S MILWAUKEE AVE, STE 181, LIBERTYVILLE, IL 60048
(847) 816-1228
(847) 816-1262

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
042-002811
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036039785
IL
Enumeration date
09/20/2005
Last updated
10/05/2012
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