Active NPI
Lake County Internal Medicine Association LLC
- Legal Medicine
- Long Grove, IL
National Provider Identifier
1265833958
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Legal Medicine
- Legal business name
- LAKE COUNTY INTERNAL MEDICINE ASSOCIATION LLC
- Practice address
- 5911 Kildeer CT
Long Grove, IL 60047-5052 - Phone
- (847) 672-8373
- Fax
- (815) 464-9285
- NPI assigned
- Sep 12, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Mariusz Milejczyk, M.D.
- Title
- M.D.
- Phone
- (847) 596-7426
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Legal Medicine | 173000000X | Primary |
Addresses
Primary practice location
5911 Kildeer CT
Long Grove, IL 60047-5052
Mailing address
5911 Kildeer CT
Long Grove, IL 60047-5052
Phone (847) 672-8373
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DT3947 | Other | IL | RAILROAD MEDICARE |
| P01139269 | Other | IL | RAILROAD MEDICARE INDIVIDUAL |
National Provider Directory
National Provider Directory- Tax ID family
- Lake County Internal Medicine Assoc LLC
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Non-Pharmacy Dispensing Site
- Gurnee, IL
- NPI 1316434376
-
- Internal Medicine Physician
- Long Grove, IL
- NPI 1154686525
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Libertyville, IL
- NPI 1467598235
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410480000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1410480000000",
"number": "1265833958",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5911 KILDEER CT",
"city": "LONG GROVE",
"state": "IL",
"postal_code": "600475052",
"telephone_number": "847-672-8373",
"fax_number": "815-464-9285"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5911 KILDEER CT",
"city": "LONG GROVE",
"state": "IL",
"postal_code": "600475052",
"telephone_number": "847-672-8373",
"fax_number": "815-464-9285"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LAKE COUNTY INTERNAL MEDICINE ASSOCIATION LLC",
"organizational_subpart": "NO",
"enumeration_date": "2014-09-12",
"last_updated": "2014-09-12",
"status": "A",
"authorized_official_last_name": "MILEJCZYK",
"authorized_official_first_name": "MARIUSZ",
"authorized_official_title_or_position": "M.D.",
"authorized_official_telephone_number": "847-596-7426",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "173000000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Legal Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "DT3947",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE INDIVIDUAL",
"identifier": "P01139269",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Long Grove, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.