Lake Forest Internal Medicine, LTD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

042617582 Issued in IL

Legal business name

LAKE FOREST INTERNAL MEDICINE, LTD

Practice address

1800 Hollister Dr
Ste 211
Libertyville, IL 60048-5263

Phone

(847) 816-3084

Fax

(847) 816-0031

NPI assigned

Aug 23, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Elliot F Miller, M.D.NPI 1164441572

Title

Vice President/ Treasurer

Phone

(847) 816-3084

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

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

• Elliot F. Miller, MD

  • Internal Medicine Physician
  • Libertyville, IL
  • NPI 1164441572
  Medicare reassignment Care Compare group Authorized official
• Mark Riederman, M.D.

  • Internal Medicine Physician
  • Libertyville, IL
  • NPI 1699782151
  Medicare reassignment Care Compare group NPD
• Nancy Chodash, NP

  • Family Nurse Practitioner
  • Libertyville, IL
  • NPI 1346371051
  NPD (past)

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

{
    "created_epoch": "1187827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351036800000",
    "number": "1871786731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 HOLLISTER DR",
            "address_2": "STE 211",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485263",
            "telephone_number": "847-816-3084",
            "fax_number": "847-816-0031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 HOLLISTER DR",
            "address_2": "STE 211",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600485263",
            "telephone_number": "847-816-3084",
            "fax_number": "847-816-0031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE FOREST INTERNAL MEDICINE, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-23",
        "last_updated": "2012-10-24",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "ELLIOT",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "VICE PRESIDENT/ TREASURER",
        "authorized_official_telephone_number": "847-816-3084",
        "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": "042617582",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake County Imaging, LLC
• Lake County Neuromonitoring, LLC
• Lake County Plastic Surgery & Vein Center LLC
• Lake County Radiology Associates, S.C.
• Lake County Smile Doctors LTD
• Lakeshore Physical Therapy, LLC
• Lakeside Dermatology
• Courtney Lamb, DDS
• Molly Lamb
• Bailey Lynn Lambert-Candaza, LCSW

• Internal Medicine Physician in Libertyville, IL
• Providers in Libertyville, 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 Oct 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.