Northern Lake Medical, Ltd.

NPI #1841247608 in Gurnee, Illinois

Provider Information

NPI Number: 1841247608
Entity Type: Organization
Organization Name: Northern Lake Medical, Ltd.
Primary Specialty: Internal Medicine
Enumeration Date: May 27, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 45 TOWER CT
Address 2: SUITE C
City: Gurnee
State: Illinois
ZIP Code: 60031-3376
Phone: (847) 623-3200

Authorized Official

Name: MARK TUCCI, M.D.
Title: PRESIDENT
Phone: (847) 587-0115

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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