1356680300 NPI number — INFECTIOUS DISEASE CONSULTANTS OF NORTHERN ILLINOIS S.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356680300 NPI number — INFECTIOUS DISEASE CONSULTANTS OF NORTHERN ILLINOIS S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INFECTIOUS DISEASE CONSULTANTS OF NORTHERN ILLINOIS S.C.
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:
1356680300
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1880 W WINCHESTER RD
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
LIBERTYVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60048-5341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-672-4940
Provider Business Mailing Address Fax Number:
847-855-5277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1880 W WINCHESTER RD
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
LIBERTYVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60048-5341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-672-4940
Provider Business Practice Location Address Fax Number:
847-855-5277
Provider Enumeration Date:
02/12/2013

Additional Information

Authorized Official

Authorized Official Last Name:
TILDEN
Authorized Official First Name:
BABETTE
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
847-672-4940

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  036-115915 , 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)





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