| NPI | 1063605178 |
|---|---|
| Former Legal Business Name | LAKE COUNTY SURGICAL, LLC |
| Entity Type | Organization |
| Authorized Contact | RONNELL LAVETT SHOWELL President/CEO 847-283-0720 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IL 238000015) |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2007-08-22 |