Provider Demographics
NPI:1285048975
Name:LAKE COUNTY IMMEDIATE CARE, LLC
Entity type:Organization
Organization Name:LAKE COUNTY IMMEDIATE CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:V
Authorized Official - Last Name:JURICA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-263-3486
Mailing Address - Street 1:65 E MONROE ST
Mailing Address - Street 2:SUITE 4726
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-5717
Mailing Address - Country:US
Mailing Address - Phone:312-753-5167
Mailing Address - Fax:
Practice Address - Street 1:724 N GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2236
Practice Address - Country:US
Practice Address - Phone:312-753-5167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care