| Lake County Neurological Associates Ltd | |
|
1616 Grand Ave Suite # 103 Waukegan IL 60085-3600 | |
| (847) 249-3100 | |
| (847) 249-3199 |
| Full Name | Lake County Neurological Associates Ltd |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1616 Grand Ave, Waukegan, Illinois |
| Authorized Official Name and Position | Peesoolal Chhabria (PRESIDENT) |
| Authorized Official Contact | 8472493100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake County Neurological Associates Ltd 1616 Grand Ave Suite # 103 Waukegan IL 60085-3600 Ph: (847) 249-3100 | Lake County Neurological Associates Ltd 1616 Grand Ave Suite # 103 Waukegan IL 60085-3600 Ph: (847) 249-3100 |
| NPI Number | 1639163686 |
|---|---|
| Provider Enumeration Date | 09/06/2005 |
| Last Update Date | 12/09/2021 |
| Certification Date | 12/09/2021 |
| Medicare PECOS PAC ID | 1254465164 |
|---|---|
| Medicare Enrollment ID | O20100813000903 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639163686 | NPI | - | NPPES |
| 036052849 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 036052849 (Illinois) | Primary |
| Provider Name | Pessoolal S Chhabria |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184801748 PECOS PAC ID: 1052481660 Enrollment ID: I20080609000039 |
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