1184756256 NPI number — ELGIN LABORATORY PHYSICIANS, LTD.

Table of content: (NPI 1184756256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184756256 NPI number — ELGIN LABORATORY PHYSICIANS, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELGIN LABORATORY PHYSICIANS, LTD.
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:
Provider Other Organization Name Type Code:
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:
1184756256
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
221 E LAKE ST STE 211
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ADDISON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60101-2870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-279-3994
Provider Business Mailing Address Fax Number:
630-628-6519

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 N AIRLITE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELGIN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60123-4912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-695-3200
Provider Business Practice Location Address Fax Number:
847-888-3318
Provider Enumeration Date:
03/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRITTON-KUZEL
Authorized Official First Name:
CATHERINE
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
847-695-3200

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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