NPIMap

Organization Active NPI

Surgeons of Lake County LLC

  • Surgery Physician
  • Libertyville, IL
National Provider Identifier
1417145301
Registry record updated Oct 1, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
036109065 Issued in IL
Legal business name
SURGEONS OF LAKE COUNTY LLC
Practice address
1870 W Winchester Rd
Suite 112
Libertyville, IL 60048-5358
Phone
(847) 816-7495
Fax
(847) 816-7497
NPI assigned
Oct 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2009

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

Authorized official

Name
Dr. Scott Christopher Otto, M.D.
Title
President
Phone
(847) 816-7495

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X 036109065 IL Primary

Addresses

Primary practice location

1870 W Winchester Rd
Suite 112
Libertyville, IL 60048-5358

Mailing address

1870 W Winchester Rd
Suite 112
Libertyville, IL 60048-5358
Phone (847) 816-7495

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254355200000",
    "number": "1417145301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1870 W WINCHESTER RD",
            "address_2": "SUITE 112",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485358",
            "telephone_number": "847-816-7495",
            "fax_number": "847-816-7497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1870 W WINCHESTER RD",
            "address_2": "SUITE 112",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485358",
            "telephone_number": "847-816-7495",
            "fax_number": "847-816-7497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGEONS OF LAKE COUNTY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-04",
        "last_updated": "2009-10-01",
        "status": "A",
        "authorized_official_last_name": "OTTO",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-816-7495",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "IL",
            "license": "036109065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Libertyville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2009; 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.