Dr Richard Douglas Southgate, MD | |
1000 N Westmoreland Rd # Level3, Lake Forest, IL 60045-1658 | |
(847) 535-8500 | |
(847) 535-8499 |
Full Name | Dr Richard Douglas Southgate |
---|---|
Gender | Male |
Speciality | Orthopaedic Surgery - Adult Reconstructive Orthopaedic Surgery |
Location | 1000 N Westmoreland Rd # Level3, Lake Forest, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1720303308 | NPI | - | NPPES |
MD184629 | Other | OR | OR MEDICAL LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207X00000X | Orthopaedic Surgery | 142231 (California) | Secondary |
207XS0114X | Orthopaedic Surgery - Adult Reconstructive Orthopaedic Surgery | 036162961 (Illinois) | Primary |
Entity Name | San Bernardino Medical Orthopaedic Group Inc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1336187475 PECOS PAC ID: 9335045228 Enrollment ID: O20040303001330 |
Entity Name | Optimal Health Of Ca Iii, Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1023526993 PECOS PAC ID: 4981967106 Enrollment ID: O20180420000835 |
Mailing Address | Practice Location Address |
---|---|
Dr Richard Douglas Southgate, MD 1000 N Westmoreland Rd # Level3, Lake Forest, IL 60045-1658 Ph: (847) 535-8500 | Dr Richard Douglas Southgate, MD 1000 N Westmoreland Rd # Level3, Lake Forest, IL 60045-1658 Ph: (847) 535-8500 |
Ellen V. Kroin, Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 1000 N Westmoreland Rd, Lake Forest, IL 60045 Phone: 847-535-8500 | |
Ronald Dewald, MD Orthopedic Surgery Medicare: Not Enrolled in Medicare Practice Location: 1645 W Broadland Ln, Lake Forest, IL 60045 Phone: 847-234-5841 Fax: 847-234-5919 | |
Benjamin Davis, M.D. Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 1000 N Westmoreland Rd # Level3, Lake Forest, IL 60045 Phone: 847-535-8500 Fax: 847-535-8488 | |
Daniel Mark Briggs, M.D. Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 1000 N Westmoreland Rd, Lake Forest, IL 60045 Phone: 847-535-8500 Fax: 847-535-8488 | |
Dr. Emily Anne Gilley, M.D. Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 1000 N Westmoreland Rd # Level3, Lake Forest, IL 60045 Phone: 847-535-8500 Fax: 847-535-8488 | |
Dr. David J Kaufman, M.D Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 1200 N Westmoreland Rd, Suite 100, Lake Forest, IL 60045 Phone: 847-535-8500 Fax: 847-535-8488 | |
Dr. James Russell Creath Sr., M.D. Orthopedic Surgery Medicare: Not Enrolled in Medicare Practice Location: 1345 S Wilson Dr, Lake Forest, IL 60045 Phone: 847-234-6212 |