| Lifeline Physician Llc | |
|
611 Hunter Ln Lake Forest IL 60045-4905 | |
| (240) 574-0009 | |
| Not Available |
| Full Name | Lifeline Physician Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 611 Hunter Ln, Lake Forest, Illinois |
| Authorized Official Name and Position | Rajalakshmi Sriram (PRESIDENT) |
| Authorized Official Contact | 2405740009 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifeline Physician Llc 611 Hunter Ln Lake Forest IL 60045-4905 Ph: (240) 574-0009 | Lifeline Physician Llc 611 Hunter Ln Lake Forest IL 60045-4905 Ph: (240) 574-0009 |
| NPI Number | 1841907839 |
|---|---|
| Provider Enumeration Date | 10/31/2022 |
| Last Update Date | 01/18/2024 |
| Medicare PECOS PAC ID | 4082083811 |
|---|---|
| Medicare Enrollment ID | O20221216001643 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841907839 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Elizabeth M Simon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942217153 PECOS PAC ID: 3779532569 Enrollment ID: I20050119000568 |
| Provider Name | Naomi Lockett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235536350 PECOS PAC ID: 1951626266 Enrollment ID: I20150209001171 |
| Provider Name | Suzanne Siu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497299689 PECOS PAC ID: 1759664816 Enrollment ID: I20170215001467 |
| Provider Name | Kristi Hughes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356744452 PECOS PAC ID: 8022379247 Enrollment ID: I20180305002091 |
| Provider Name | Venessann Thornton-mclendon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437656527 PECOS PAC ID: 6709136708 Enrollment ID: I20180913000152 |
| Provider Name | Nicolas Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235892431 PECOS PAC ID: 1759770183 Enrollment ID: I20211105000430 |
| Provider Name | Hadi S Tolooi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770832586 PECOS PAC ID: 6406000512 Enrollment ID: I20221220001392 |
| Provider Name | Wesley Nahm |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1720009590 PECOS PAC ID: 7113906561 Enrollment ID: I20230130002192 |
| Provider Name | Erin Mcnulty |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952099012 PECOS PAC ID: 4789041419 Enrollment ID: I20230612000465 |
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Lake Forest Pediatric Associates, Ltd Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 900 N Westmoreland Rd, Suite 110, Lake Forest, IL 60045 Phone: 847-295-1220 Fax: 847-295-1255 | |
Kurt J Brotherson Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 840 S Waukegan Rd, 203, Lake Forest, IL 60045 Phone: 847-482-0136 |