| Waukegan Clinic Corp | |
|
200 S Greenleaf St Suite A Gurnee IL 60031-3398 | |
| (847) 360-3000 | |
| Not Available |
| Full Name | Waukegan Clinic Corp |
|---|---|
| Speciality | Family Medicine |
| Location | 200 S Greenleaf St, Gurnee, Illinois |
| Authorized Official Name and Position | Debbie Brewer (DIRECTOR OF PROVIDER ENROLLMENT) |
| Authorized Official Contact | 6154657000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Waukegan Clinic Corp 7100 Commerce Way Suite 180 Brentwood TN 37027-2829 Ph: (615) 465-7626 | Waukegan Clinic Corp 200 S Greenleaf St Suite A Gurnee IL 60031-3398 Ph: (847) 360-3000 |
| NPI Number | 1306937289 |
|---|---|
| Provider Enumeration Date | 09/27/2006 |
| Last Update Date | 09/05/2007 |
| Medicare PECOS PAC ID | 4284631086 |
|---|---|
| Medicare Enrollment ID | O20061108000240 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306937289 | NPI | - | NPPES |
| Provider Name | Ninad Dixit |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922094655 PECOS PAC ID: 6305740507 Enrollment ID: I20031120000330 |
| Provider Name | Bruce Mackenzie |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1720185507 PECOS PAC ID: 9436042272 Enrollment ID: I20040205000141 |
| Provider Name | Craig A Davishoff |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1861507345 PECOS PAC ID: 4981685120 Enrollment ID: I20040525001111 |
| Provider Name | Joyce Turley |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1871609677 PECOS PAC ID: 2466433180 Enrollment ID: I20040528000061 |
| Provider Name | Daisy S Andaleon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093723413 PECOS PAC ID: 9931185105 Enrollment ID: I20040628001014 |
| Provider Name | Thomas P Carmody |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1275534406 PECOS PAC ID: 9032107727 Enrollment ID: I20040825000310 |
| Provider Name | Rakhshanda B Neelam |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1245217611 PECOS PAC ID: 5991764391 Enrollment ID: I20041008001394 |
| Provider Name | Eno A Nsima-obot |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033180245 PECOS PAC ID: 2860440351 Enrollment ID: I20050111001011 |
| Provider Name | Joseph Craig |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1730193186 PECOS PAC ID: 9133178890 Enrollment ID: I20050120000031 |
| Provider Name | Galina Simkin |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1487655833 PECOS PAC ID: 6002866209 Enrollment ID: I20050126000029 |
| Provider Name | Uzoma C Okoli |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1538168620 PECOS PAC ID: 5799737912 Enrollment ID: I20050216000433 |
| Provider Name | Yiping Fu |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1043205107 PECOS PAC ID: 6305888405 Enrollment ID: I20050602000705 |
| Provider Name | Mahesh Kumar Agarwal |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1730238874 PECOS PAC ID: 4688606916 Enrollment ID: I20050910000069 |
| Provider Name | Gerald A Frank |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912043787 PECOS PAC ID: 1951325430 Enrollment ID: I20060207000138 |
| Provider Name | Sheikh Muhammed Sadiq |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1164474102 PECOS PAC ID: 3971511098 Enrollment ID: I20060331000361 |
| Provider Name | Rachel Anita Goldstein |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1346287521 PECOS PAC ID: 0143129577 Enrollment ID: I20060413000316 |
| Provider Name | Mathai S Karingada |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831125988 PECOS PAC ID: 7618971045 Enrollment ID: I20060828000041 |
| Provider Name | Uday K Paul |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982623575 PECOS PAC ID: 9133123318 Enrollment ID: I20060830000293 |
| Provider Name | Jamil Abdur Rahman |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1710914189 PECOS PAC ID: 2860499506 Enrollment ID: I20061023000399 |
| Provider Name | Marina Gladson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588751366 PECOS PAC ID: 4688671183 Enrollment ID: I20061025000674 |
| Provider Name | Tzvetan Tochkov Naydenov |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134141195 PECOS PAC ID: 8224035415 Enrollment ID: I20061101000115 |
| Provider Name | Caroline E Cinquegrani |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1649353251 PECOS PAC ID: 1850399791 Enrollment ID: I20061201000191 |
| Provider Name | Steven G Sclamberg |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1538112255 PECOS PAC ID: 7113926213 Enrollment ID: I20061219000529 |
| Provider Name | Andrew Albert |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1659413656 PECOS PAC ID: 4082710561 Enrollment ID: I20070430000153 |
| Provider Name | Alan Auerbach |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1902913759 PECOS PAC ID: 6507962917 Enrollment ID: I20070501000678 |
| Provider Name | Kenji Oyasu |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1487768552 PECOS PAC ID: 9739285941 Enrollment ID: I20070504000331 |
| Provider Name | Richard A Margolin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528162062 PECOS PAC ID: 4486735867 Enrollment ID: I20080111000522 |
| Provider Name | Sara Ferrera |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1356510788 PECOS PAC ID: 7315016938 Enrollment ID: I20080521000678 |
| Provider Name | Asif Anwar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134179450 PECOS PAC ID: 0244253714 Enrollment ID: I20080730000728 |
| Provider Name | Jason Benjamin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1912169780 PECOS PAC ID: 3274608377 Enrollment ID: I20080826000040 |
| Provider Name | Noura Mohamed Sharabash |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629250501 PECOS PAC ID: 4183791403 Enrollment ID: I20080927000196 |
| Provider Name | Lavanya Srinivasan |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1447452610 PECOS PAC ID: 4789751967 Enrollment ID: I20080930000608 |
| Provider Name | Evyan Jawad |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1740443506 PECOS PAC ID: 1456429984 Enrollment ID: I20081009000756 |
| Provider Name | Tammy L Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972769073 PECOS PAC ID: 9133288392 Enrollment ID: I20081104000172 |
| Provider Name | Ninef E Zaya |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1962624031 PECOS PAC ID: 1759440217 Enrollment ID: I20081112000743 |
| Provider Name | Vikas Bhatara |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1811026446 PECOS PAC ID: 5496762726 Enrollment ID: I20081223000533 |
| Provider Name | Susan H Hansel |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1962530808 PECOS PAC ID: 6305909862 Enrollment ID: I20090108000717 |
| Provider Name | Sahar Ahmad |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1740264696 PECOS PAC ID: 6204803141 Enrollment ID: I20090622000435 |
| Provider Name | Kimberly L Morstadt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639370083 PECOS PAC ID: 0042351611 Enrollment ID: I20100104000677 |
| Provider Name | Naren A Kapadia |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1457307118 PECOS PAC ID: 3173615564 Enrollment ID: I20100610000881 |
| Provider Name | Catherine M Goodale |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790938546 PECOS PAC ID: 8022149566 Enrollment ID: I20100628000901 |
| Provider Name | Nilesh Mehta |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1578502159 PECOS PAC ID: 5991897381 Enrollment ID: I20100702000007 |
| Provider Name | Jai J Nho |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1780670018 PECOS PAC ID: 0648304774 Enrollment ID: I20100811000980 |
| Provider Name | Alpesh M Patel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720287378 PECOS PAC ID: 6901920446 Enrollment ID: I20100903000870 |
| Provider Name | Neil H Puller |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1932204302 PECOS PAC ID: 7618967340 Enrollment ID: I20101123001075 |
| Provider Name | Mathangi Sekharan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518959329 PECOS PAC ID: 4082800289 Enrollment ID: I20101130001186 |
| Provider Name | Mehul Soni |
|---|---|
| Provider Type | Practitioner - Surgical Oncology |
| Provider Identifiers | NPI Number: 1265609739 PECOS PAC ID: 9830256528 Enrollment ID: I20101130001407 |
| Provider Name | Gini Dutt |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316137656 PECOS PAC ID: 6901093566 Enrollment ID: I20101208000397 |
| Provider Name | Peter M Oshin |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1093732331 PECOS PAC ID: 7517154156 Enrollment ID: I20101209000038 |
| Provider Name | Kimberly Orlob |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1851377808 PECOS PAC ID: 7214126655 Enrollment ID: I20110114001059 |
| Provider Name | Karama Thiab |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811923709 PECOS PAC ID: 3779764006 Enrollment ID: I20110221000234 |
| Provider Name | Anita Bhardwaj |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023264819 PECOS PAC ID: 9335323302 Enrollment ID: I20110415000522 |
| Provider Name | Martin Joel Weiner |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1285629063 PECOS PAC ID: 2567360522 Enrollment ID: I20110707000304 |
| Provider Name | Laura A Murphy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609023068 PECOS PAC ID: 4486823283 Enrollment ID: I20110812000112 |
| Provider Name | Timothy G Stegemann |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861557399 PECOS PAC ID: 7719159557 Enrollment ID: I20111020000344 |
| Provider Name | Sulaiman Mohammad |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1407185499 PECOS PAC ID: 2264624568 Enrollment ID: I20111208000078 |
| Provider Name | Peter T Senatore |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1700865656 PECOS PAC ID: 1052587227 Enrollment ID: I20120110000644 |
| Provider Name | Joseph D Spennetta |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1700993458 PECOS PAC ID: 1658378096 Enrollment ID: I20120130000084 |
| Provider Name | Antonio T Mister |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104079185 PECOS PAC ID: 8527228907 Enrollment ID: I20120321000687 |
| Provider Name | Srikanth Davuluri |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1205034998 PECOS PAC ID: 0244493658 Enrollment ID: I20120523000139 |
| Provider Name | Brent Cutro |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346479474 PECOS PAC ID: 1658535919 Enrollment ID: I20120618000236 |
| Provider Name | Arden Davis Barnett |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1891765095 PECOS PAC ID: 5496773525 Enrollment ID: I20120627000166 |
| Provider Name | Ryan M Pizinger |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1255438735 PECOS PAC ID: 5597937599 Enrollment ID: I20120807000283 |
| Provider Name | Ryan N Chellin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1952536104 PECOS PAC ID: 2365691540 Enrollment ID: I20121003000374 |
| Provider Name | Lizel Granada |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619213618 PECOS PAC ID: 8022263425 Enrollment ID: I20130311000482 |
| Provider Name | James J Murtagh |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1760655526 PECOS PAC ID: 5991859456 Enrollment ID: I20130604000181 |
| Provider Name | Alla A Bodner |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1669723573 PECOS PAC ID: 8921241670 Enrollment ID: I20130827000869 |
| Provider Name | Sherry A Owen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417047135 PECOS PAC ID: 0042446759 Enrollment ID: I20131127001698 |
| Provider Name | Binn M Jatta |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1255565115 PECOS PAC ID: 8921236340 Enrollment ID: I20140110000550 |
| Provider Name | Olga Geniyevna Kozlova |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1477997674 PECOS PAC ID: 5991924763 Enrollment ID: I20140910001963 |
| Provider Name | Hythem P Shadid |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1477567394 PECOS PAC ID: 8628056827 Enrollment ID: I20150114001589 |
| Provider Name | Jarrod Barker |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1801013164 PECOS PAC ID: 6800074956 Enrollment ID: I20150311001665 |
| Provider Name | Lauren Snower |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639459597 PECOS PAC ID: 4688812878 Enrollment ID: I20150511002096 |
| Provider Name | Poornima Pandellapalli |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1205933850 PECOS PAC ID: 8224129655 Enrollment ID: I20150512002975 |
| Provider Name | Timothy M Volk |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801141726 PECOS PAC ID: 0941448773 Enrollment ID: I20150803000331 |
| Provider Name | Jennifer Clevenger |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1740656438 PECOS PAC ID: 6608184098 Enrollment ID: I20151005002358 |
| Provider Name | Kunal Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548600240 PECOS PAC ID: 8426342502 Enrollment ID: I20160812000267 |
| Provider Name | Caitlin Marie Dore |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1619231396 PECOS PAC ID: 6305142365 Enrollment ID: I20160816001643 |
| Provider Name | Rushim S Bains |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154334316 PECOS PAC ID: 3173627148 Enrollment ID: I20160909002552 |
| Provider Name | Anterpreet P Dhanoyia |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1497017230 PECOS PAC ID: 3173767795 Enrollment ID: I20160928000592 |
| Provider Name | Jennifer Luzentales |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366896631 PECOS PAC ID: 7719261718 Enrollment ID: I20170310000023 |
| Provider Name | Shazia Kamran |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1992950166 PECOS PAC ID: 6507014578 Enrollment ID: I20170612003010 |
| Provider Name | Haili Campanella |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184151193 PECOS PAC ID: 5294003158 Enrollment ID: I20170616002095 |
| Provider Name | Sheila B Atendido |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1609308139 PECOS PAC ID: 1052680592 Enrollment ID: I20170627001544 |
| Provider Name | Robert Paul Cafe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437651072 PECOS PAC ID: 8022371590 Enrollment ID: I20180416000555 |
| Provider Name | Mary Maish |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1750316774 PECOS PAC ID: 0547226789 Enrollment ID: I20181129000993 |
| Provider Name | Aswin Nukala |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093155350 PECOS PAC ID: 2466710637 Enrollment ID: I20190214002970 |
| Provider Name | Paolo P Mercado |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447728183 PECOS PAC ID: 5496094914 Enrollment ID: I20190228000448 |
| Provider Name | Gordon W Dowds |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1134115710 PECOS PAC ID: 4789747833 Enrollment ID: I20190514002248 |
| Provider Name | Corbin Joseph Barwegen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1518315464 PECOS PAC ID: 2163700733 Enrollment ID: I20190710000277 |
| Provider Name | Carizza Senas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801440045 PECOS PAC ID: 7113256660 Enrollment ID: I20190909001022 |
| Provider Name | Arlyn Joy Quitevis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871158998 PECOS PAC ID: 8921428921 Enrollment ID: I20201013001505 |
| Provider Name | Amin Namazi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821475120 PECOS PAC ID: 9537473889 Enrollment ID: I20201102001806 |
| Provider Name | Marlon Viloria |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912514654 PECOS PAC ID: 1153515598 Enrollment ID: I20210218001249 |
| Provider Name | Victoria Gennadievna Zubovich |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598434540 PECOS PAC ID: 7517364821 Enrollment ID: I20210928003241 |
| Provider Name | Anil Kumar Krishna Pattisapu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962765503 PECOS PAC ID: 4789820291 Enrollment ID: I20211019000095 |
| Provider Name | Kumar Gaurav |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1467617902 PECOS PAC ID: 5496971905 Enrollment ID: I20211105000137 |
| Provider Name | Steve Fankam |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1255910014 PECOS PAC ID: 8628468667 Enrollment ID: I20211206000806 |
| Provider Name | Aaron Galbraith |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871835124 PECOS PAC ID: 5597909945 Enrollment ID: I20220223002640 |
| Provider Name | Mutsa Vollmer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356989032 PECOS PAC ID: 1951727155 Enrollment ID: I20220302001861 |
| Provider Name | Chelsie Lisle |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1720634496 PECOS PAC ID: 2264856079 Enrollment ID: I20220329001293 |
| Provider Name | Thomas L Schaefer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629718879 PECOS PAC ID: 0547649881 Enrollment ID: I20220616002690 |
| Provider Name | Evgenii Raikovskii |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477114643 PECOS PAC ID: 4981083045 Enrollment ID: I20220620001495 |
| Provider Name | Eduardo Ornelas |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1942892385 PECOS PAC ID: 5698155935 Enrollment ID: I20220705002301 |
| Provider Name | Deepika Ranjit |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407408073 PECOS PAC ID: 7719369586 Enrollment ID: I20220727001407 |
| Provider Name | Shivon Manchanda |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1730640905 PECOS PAC ID: 2466788468 Enrollment ID: I20220903000466 |
| Provider Name | Cleotha A Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477271633 PECOS PAC ID: 5092190413 Enrollment ID: I20220920003580 |
| Provider Name | Yusra Moursy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023468840 PECOS PAC ID: 8123312659 Enrollment ID: I20221222001403 |
| Provider Name | Swetha Kattetota Muralidhara |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1598312837 PECOS PAC ID: 7719358506 Enrollment ID: I20230112002643 |
| Provider Name | Amanda Sharrell Thomas |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1275196065 PECOS PAC ID: 4183950017 Enrollment ID: I20230213001464 |
| Provider Name | Melissa Marguerite Urban |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518657170 PECOS PAC ID: 0244697738 Enrollment ID: I20230526000296 |
| Provider Name | Wallis Olivia Edwards |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427676113 PECOS PAC ID: 5991174310 Enrollment ID: I20230613003783 |
| Provider Name | Sara Conner |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1578239265 PECOS PAC ID: 4789044546 Enrollment ID: I20230712002809 |
| Provider Name | Alonzo Tyrone Sexton |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1780617365 PECOS PAC ID: 3173536265 Enrollment ID: I20230824001941 |
| Provider Name | Ahadi Hakki |
|---|---|
| Provider Type | Practitioner - Thoracic Surgery |
| Provider Identifiers | NPI Number: 1194816389 PECOS PAC ID: 5496800997 Enrollment ID: I20231013002708 |
| Provider Name | Kemal Kucuk |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053844142 PECOS PAC ID: 7214205764 Enrollment ID: I20231120001771 |
| Provider Name | Amy Jo Brogley |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1598335564 PECOS PAC ID: 7911356092 Enrollment ID: I20231214002134 |
| Provider Name | Rowell Angeles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528829892 PECOS PAC ID: 9931543444 Enrollment ID: I20240222003055 |
| Provider Name | Fritz Gerald Mesilien |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1073914511 PECOS PAC ID: 2961725106 Enrollment ID: I20240304001196 |
| Provider Name | Erick M Mccormick |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1366189250 PECOS PAC ID: 8527414713 Enrollment ID: I20240306000339 |
| Provider Name | Joseph P Mcvicker |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1346211737 PECOS PAC ID: 0143211151 Enrollment ID: I20240322002937 |
| Provider Name | William Keates |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750579942 PECOS PAC ID: 3971673708 Enrollment ID: I20240528001888 |
| Provider Name | David Aaron Rosen |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1558458463 PECOS PAC ID: 7315974730 Enrollment ID: I20240603002104 |
| Provider Name | Patrick Bonaparte |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508260340 PECOS PAC ID: 5193090280 Enrollment ID: I20240625000976 |
| Provider Name | Ekaterina A Good |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104445782 PECOS PAC ID: 4880037332 Enrollment ID: I20240628000105 |
| Provider Name | Rajashekar Kumar |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871858514 PECOS PAC ID: 5294980637 Enrollment ID: I20240814003662 |
| Provider Name | Kamal Ibrahim |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1205862067 PECOS PAC ID: 6305890260 Enrollment ID: I20240814003747 |
| Provider Name | Siva Rama Krishna Marri |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1366755126 PECOS PAC ID: 5294030300 Enrollment ID: I20240814003817 |
| Provider Name | Sarah Kung |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1891182010 PECOS PAC ID: 8426345679 Enrollment ID: I20240819002259 |
| Provider Name | Stefanie Colavito |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1548282916 PECOS PAC ID: 1355393034 Enrollment ID: I20240821001874 |
| Provider Name | Barbara Newberg |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1124014071 PECOS PAC ID: 2062548142 Enrollment ID: I20240821004488 |
| Provider Name | William Cho |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821397407 PECOS PAC ID: 3375769607 Enrollment ID: I20240924001805 |
| Provider Name | Sidney Blake |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093800245 PECOS PAC ID: 9739267246 Enrollment ID: I20240924003414 |
| Provider Name | Vijaya Gandla |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1821024100 PECOS PAC ID: 5294739611 Enrollment ID: I20240926002756 |
| Provider Name | Kelli Mathew |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1386962223 PECOS PAC ID: 0941441240 Enrollment ID: I20241001001303 |
| Provider Name | Melinda Mantooth |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1639708175 PECOS PAC ID: 3476972381 Enrollment ID: I20241024004321 |
M P M Family Health Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1445 N Hunt Club Rd, Suite 304, Gurnee, IL 60031 Phone: 847-383-5428 | |
Hosep H Deyrmenjian, Md, Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6440 Grand Ave, Suite 205, Gurnee, IL 60031 Phone: 847-855-3150 Fax: 847-855-3143 | |
Chicago Medical Clinic Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 200 S Greenleaf St, Suite A, Gurnee, IL 60031 Phone: 847-596-4521 | |
Gurnee Stone Medical Center P.c Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7505 Grand Ave, Gurnee, IL 60031 Phone: 847-856-7615 | |
Lake Shore Gastroenterolgy Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 20 Tower Ct, Suite C, Gurnee, IL 60031 Phone: 847-244-6320 Fax: 847-244-5095 |