Michael Lee Primack, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019-013904 Issued in IL

Practice address

860 Waveland Rd
Lake Forest, IL 60045-3944

Phone

(847) 234-2416

NPI assigned

Aug 29, 2006

Last updated

Feb 5, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233792000000",
    "number": "1710095542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "860 WAVELAND RD",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600453944",
            "telephone_number": "847-234-2416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "860 WAVELAND RD",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600453944",
            "telephone_number": "847-234-2416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIMACK",
        "first_name": "MICHAEL",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2009-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-013904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Posture Palooza (Physical Therapy of Lake Forrest, LLC)
• Ramanujam Govindarajan Prativadi, MD
• Presbyterian Homes (Lake Forest Place)
• Presbyterian Homes (Lake Forest Place)
• Adam E Prescott, MD
• Bernard B Pritzker, M.D.
• Amalia Maria Prodanovic
• Nancy Pudrycki, M.S., CCC-SLP
• Clare Driggs Purcell, MD
• Joseph Matthew Purpura, M.D.

• General Practice Dentistry in Lake Forest, IL
• Providers in Lake Forest, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 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.