Provider Demographics
NPI:1902931025
Name:LOMBARD FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:LOMBARD FAMILY HEALTH CENTER
Other - Org Name:LOMBARD FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:YONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-629-0017
Mailing Address - Street 1:126 W SAINT CHARLES RD
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-2231
Mailing Address - Country:US
Mailing Address - Phone:630-629-0017
Mailing Address - Fax:
Practice Address - Street 1:126 W SAINT CHARLES RD
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-2231
Practice Address - Country:US
Practice Address - Phone:630-629-0017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052942261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL730952OtherCOMMERCIAL
IL36052942Medicaid
IL2215686OtherBCBS
IL961550Medicare PIN