| Gundersen Lutheran Medical Center Inc | |
|
14780 Creekside Path Libertyville IL 60048-1107 | |
| (608) 782-7300 | |
| Not Available |
| Full Name | Gundersen Lutheran Medical Center Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 14780 Creekside Path, Libertyville, Illinois |
| Authorized Official Name and Position | Kari B Adank (VP) |
| Authorized Official Contact | 6087758025 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gundersen Lutheran Medical Center Inc 1910 South Ave La Crosse WI 54601-5467 Ph: (608) 782-7300 | Gundersen Lutheran Medical Center Inc 14780 Creekside Path Libertyville IL 60048-1107 Ph: (608) 782-7300 |
| NPI Number | 1144947805 |
|---|---|
| Provider Enumeration Date | 10/24/2022 |
| Last Update Date | 10/24/2022 |
| Medicare PECOS PAC ID | 2163331414 |
|---|---|
| Medicare Enrollment ID | O20221121000252 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144947805 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Gregory E Salton |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1861502023 PECOS PAC ID: 4688561087 Enrollment ID: I20090812000816 |
| Provider Name | Christopher W Grant |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1114212040 PECOS PAC ID: 9931409265 Enrollment ID: I20170908001565 |
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