| Lake Forest Internal Medicine, Ltd | |
|
1800 Hollister Dr Ste 211 Libertyville IL 60048-5263 | |
| (847) 816-3084 | |
| (847) 816-0031 |
| Full Name | Lake Forest Internal Medicine, Ltd |
|---|---|
| Speciality | Internal Medicine |
| Location | 1800 Hollister Dr, Libertyville, Illinois |
| Authorized Official Name and Position | Elliot F Miller (VICE PRESIDENT/ TREASURER) |
| Authorized Official Contact | 8478163084 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Forest Internal Medicine, Ltd 1800 Hollister Dr Ste 211 Libertyville IL 60048-5263 Ph: (847) 816-3084 | Lake Forest Internal Medicine, Ltd 1800 Hollister Dr Ste 211 Libertyville IL 60048-5263 Ph: (847) 816-3084 |
| NPI Number | 1871786731 |
|---|---|
| Provider Enumeration Date | 08/23/2007 |
| Last Update Date | 10/24/2012 |
| Medicare PECOS PAC ID | 3173703097 |
|---|---|
| Medicare Enrollment ID | O20110210000305 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871786731 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 042617582 (Illinois) | Primary |
| Provider Name | Elliot F Miller |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164441572 PECOS PAC ID: 2567642390 Enrollment ID: I20110210000582 |
| Provider Name | Mark Riederman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699782151 PECOS PAC ID: 4183804917 Enrollment ID: I20110328000815 |
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