Provider Demographics
NPI:1588709281
Name:LINCOLN SQUARE MEDICAL ASSOCIATES, LTD.
Entity type:Organization
Organization Name:LINCOLN SQUARE MEDICAL ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-385-6529
Mailing Address - Street 1:6923 W SHAKESPEARE AVE
Mailing Address - Street 2:#2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-3355
Mailing Address - Country:US
Mailing Address - Phone:773-385-6529
Mailing Address - Fax:773-385-6673
Practice Address - Street 1:5140 N CALIFORNIA AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3645
Practice Address - Country:US
Practice Address - Phone:773-989-3803
Practice Address - Fax:773-878-5726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK36740OtherMEDICARE PROVIDER ID
IL036070498Medicaid
IL922001Medicare PIN
ILK36740OtherMEDICARE PROVIDER ID