1588709281 NPI number — LINCOLN SQUARE MEDICAL ASSOCIATES, LTD.

Table of content: (NPI 1588709281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588709281 NPI number — LINCOLN SQUARE MEDICAL ASSOCIATES, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINCOLN SQUARE MEDICAL ASSOCIATES, 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:
1588709281
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6923 W SHAKESPEARE AVE
Provider Second Line Business Mailing Address:
#2
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60707-3355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-385-6529
Provider Business Mailing Address Fax Number:
773-385-6673

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5140 N CALIFORNIA AVE
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60625-3645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-989-3803
Provider Business Practice Location Address Fax Number:
773-878-5726
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ZUK
Authorized Official First Name:
OLGA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
773-385-6529

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: K36740 . This is a "MEDICARE PROVIDER ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036070498 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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