Organization
LAKE FOREST MEDICAL SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT E BRAUNLICH M.D. (PRESIDENT)
(847) 604-8144
Entity
Organization
Contact information
Practice address
800 N WESTMORELAND RD, SUITE 100, LAKE FOREST, IL 60045-1673
(847) 604-8144
(847) 234-4682
Mailing address
800 N WESTMORELAND RD, SUITE 100, LAKE FOREST, IL 60045-1673
(847) 604-8144
(847) 234-4682
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
042618006
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042618006
REGISTERED MEDICAL CORP.
IL
Enumeration date
11/30/2005
Last updated
05/12/2009
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