| Family Medical Center Of Lagrange Ltd | |
|
5201 S Willow Springs Road Suite 300 Lagrange IL 60525 | |
| (708) 482-8088 | |
| (708) 482-9034 |
| Full Name | Family Medical Center Of Lagrange Ltd |
|---|---|
| Speciality | Family Medicine |
| Location | 5201 S Willow Springs Road, Lagrange, Illinois |
| Authorized Official Name and Position | Michael Francis Dupont (VICE PRESIDENT PHYSICIAN) |
| Authorized Official Contact | 7084828088 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Medical Center Of Lagrange Ltd 5201 S Willow Springs Road Suite 300 Lagrange IL 60525 Ph: (708) 482-8088 | Family Medical Center Of Lagrange Ltd 5201 S Willow Springs Road Suite 300 Lagrange IL 60525 Ph: (708) 482-8088 |
| NPI Number | 1649355793 |
|---|---|
| Provider Enumeration Date | 10/26/2006 |
| Last Update Date | 11/05/2012 |
| Medicare PECOS PAC ID | 0749243939 |
|---|---|
| Medicare Enrollment ID | O20041109000404 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649355793 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Daniel Chen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356355812 PECOS PAC ID: 8921100751 Enrollment ID: I20070226000655 |
| Provider Name | Scott D Robertson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376553875 PECOS PAC ID: 6901861772 Enrollment ID: I20101102001356 |
| Provider Name | Michael Dupont |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508817750 PECOS PAC ID: 5991760761 Enrollment ID: I20101103000257 |
| Provider Name | Prachi I Patel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1144545849 PECOS PAC ID: 2860615119 Enrollment ID: I20140514001084 |
| Provider Name | Samuel J Traverso |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902464647 PECOS PAC ID: 4587091343 Enrollment ID: I20230210000201 |