Provider Demographics
NPI:1730205931
Name:WEST SUBURBAN FAMILY PRACTICE ASSOCIATES LTD.
Entity type:Organization
Organization Name:WEST SUBURBAN FAMILY PRACTICE ASSOCIATES LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUBKEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:708-456-4420
Mailing Address - Street 1:7632 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-4143
Mailing Address - Country:US
Mailing Address - Phone:708-456-4420
Mailing Address - Fax:708-456-9817
Practice Address - Street 1:7632 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-4143
Practice Address - Country:US
Practice Address - Phone:708-456-4420
Practice Address - Fax:708-456-9817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0161542066OtherBCBS
IL606200Medicare ID - Type Unspecified