Provider Demographics
NPI:1386665560
Name:DEERFIELD-BANNOCKBURN FIRE DEPARTMENT
Entity type:Organization
Organization Name:DEERFIELD-BANNOCKBURN FIRE DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-945-4066
Mailing Address - Street 1:395 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-1508
Mailing Address - Country:US
Mailing Address - Phone:630-903-2240
Mailing Address - Fax:630-903-2830
Practice Address - Street 1:500 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4373
Practice Address - Country:US
Practice Address - Phone:847-945-8951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1072783416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214123OtherMEDICARE
IL04932588OtherBLUE CROSS BLUE SHIELD
IL04932588OtherBLUE CROSS BLUE SHIELD