| Katrina Lake Md Llc | |
|
18503 Bellamy Rd Country Club Hills IL 60478-5279 | |
| (708) 365-8343 | |
| Not Available |
| Full Name | Katrina Lake Md Llc |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 18503 Bellamy Rd, Country Club Hills, Illinois |
| Authorized Official Name and Position | Katrina Lake (OWNER) |
| Authorized Official Contact | 7083088974 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Katrina Lake Md Llc 18503 Bellamy Rd Country Club Hills IL 60478-5279 Ph: () - | Katrina Lake Md Llc 18503 Bellamy Rd Country Club Hills IL 60478-5279 Ph: (708) 365-8343 |
| NPI Number | 1013536663 |
|---|---|
| Provider Enumeration Date | 04/14/2020 |
| Last Update Date | 05/01/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013536663 | NPI | - | NPPES |
| 036141229 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |