| North Suburban Family Physicians | |
|
1256 American Way Libertyville IL 60048-3936 | |
| (224) 424-4624 | |
| (224) 424-4631 |
| Full Name | North Suburban Family Physicians |
|---|---|
| Speciality | Clinic/Center |
| Location | 1256 American Way, Libertyville, Illinois |
| Authorized Official Name and Position | Thomas Michael Mcgowan (OWNER) |
| Authorized Official Contact | 2244244624 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| North Suburban Family Physicians 1252-1256 American Way Libertyville IL 60048-3936 Ph: (224) 424-4624 | North Suburban Family Physicians 1256 American Way Libertyville IL 60048-3936 Ph: (224) 424-4624 |
| NPI Number | 1740635432 |
|---|---|
| Provider Enumeration Date | 04/29/2016 |
| Last Update Date | 02/12/2019 |
| Medicare PECOS PAC ID | 4880987361 |
|---|---|
| Medicare Enrollment ID | O20160720002479 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740635432 | NPI | - | NPPES |
| 036105977 | Other | IL | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 036105977 (Illinois) | Primary |
| Provider Name | Thomas M Mcgowan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033173893 PECOS PAC ID: 5193758282 Enrollment ID: I20050919000476 |
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