1023047164 NPI number — COUNTY OF LAKE

Table of content: MARIAM ZAMAN MD (NPI 1598441727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023047164 NPI number — COUNTY OF LAKE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF LAKE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LAKE COUNTY HEALTH DEPARTMENT AND COMMUNITY HEALTH CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023047164
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3010 GRAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUKEGAN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60085-2321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-377-8000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1911 27TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZION
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60099-2542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-377-8800
Provider Business Practice Location Address Fax Number:
847-872-0384
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PFISTER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
847-377-8000

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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