Lake Cicero Clinic, S.C.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036085519 Issued in IL

Legal business name

LAKE CICERO CLINIC, S.C.

Doing business as

Lake Cicero Clinic

Practice address

4801 W Lake St
Chicago, IL 60644-2609

Phone

(773) 378-8100

NPI assigned

Sep 10, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Gurcharan Singh Randhawa, M.D.

Title

Owner - Physician

Phone

(773) 378-8100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lake Cicero Clinic Doing business as

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

{
    "created_epoch": "1347235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347235200000",
    "number": "1336498062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 W LAKE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606442609",
            "telephone_number": "773-378-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 W LAKE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606442609",
            "telephone_number": "773-378-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE CICERO CLINIC, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-10",
        "last_updated": "2012-09-10",
        "status": "A",
        "authorized_official_last_name": "RANDHAWA",
        "authorized_official_first_name": "GURCHARAN",
        "authorized_official_middle_name": "SINGH",
        "authorized_official_title_or_position": "OWNER - PHYSICIAN",
        "authorized_official_telephone_number": "773-378-8100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036085519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1639206535",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Cicero Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Internal Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2012; 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.