| Lake County Neuromonitoring, Llc | |
|
712 S Milwaukee Avenue Libertyville IL 60048 | |
| (847) 362-1848 | |
| (847) 362-3351 |
| Full Name | Lake County Neuromonitoring, Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 712 S Milwaukee Avenue, Libertyville, Illinois |
| Authorized Official Name and Position | Jonathan S Citow (OWNER) |
| Authorized Official Contact | 8473621848 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake County Neuromonitoring, Llc 712 S Milwaukee Avenue Libertyville IL 60048 Ph: (847) 362-1848 | Lake County Neuromonitoring, Llc 712 S Milwaukee Avenue Libertyville IL 60048 Ph: (847) 362-1848 |
| NPI Number | 1679718977 |
|---|---|
| Provider Enumeration Date | 12/16/2008 |
| Last Update Date | 02/06/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679718977 | NPI | - | NPPES |
| 036082394 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 036082394 (Illinois) | Primary |
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