Lake County Pediatrics SC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

LAKE COUNTY PEDIATRICS SC

Practice address

200 S Greenleaf Ave
Suite E
Gurnee, IL 60031

Phone

(847) 336-0770

Fax

(847) 336-0159

NPI assigned

Jan 3, 2008

Last updated

Jan 3, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marlene Juco Tanquilut, MDNPI 1083782908

Title

President

Phone

(847) 336-0770

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Marlene Juco Tanquilut, MD

  • Pediatrics Physician
  • Gurnee, IL
  • NPI 1083782908
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1199318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199318400000",
    "number": "1114102530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 S GREENLEAF AVE",
            "address_2": "SUITE E",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "60031",
            "telephone_number": "847-336-0770",
            "fax_number": "847-336-0159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S GREENLEAF AVE",
            "address_2": "SUITE E",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "60031",
            "telephone_number": "847-336-0770",
            "fax_number": "847-336-0159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE COUNTY PEDIATRICS SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-03",
        "last_updated": "2008-01-03",
        "status": "A",
        "authorized_official_last_name": "TANQUILUT",
        "authorized_official_first_name": "MARLENE",
        "authorized_official_middle_name": "JUCO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-336-0770",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake County Acute Care, LLP
• Lake County Center, LLC
• Lake County General and Vascular Surgical Associates, P.C.
• Lake County Head and Neck Specialists S.C.
• Lake County Internal Medicine Assoc LLC
• Lake County Primary Care S.C.
• Lake County Vein Specialists, SC
• Lake Harbor Behavioral Health, LLC
• Lake Heart Specialists (Drs. Jajeh & Koch SC)
• Lake Shore Gastroenterolgy SC

• Pediatrics Physician in Gurnee, IL
• Providers in Gurnee, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.