Provider Demographics
NPI:1518016989
Name:LINCOLN PARK HEARING CENTER
Entity type:Organization
Organization Name:LINCOLN PARK HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SIEFERT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-A
Authorized Official - Phone:773-883-3711
Mailing Address - Street 1:550 W WEBSTER AVE
Mailing Address - Street 2:LINCOLN PARK HEARING CENTER
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3965
Mailing Address - Country:US
Mailing Address - Phone:773-883-3711
Mailing Address - Fax:773-883-3764
Practice Address - Street 1:5480 CASCADE DR
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-2043
Practice Address - Country:US
Practice Address - Phone:773-883-3711
Practice Address - Fax:773-883-3764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL323429544-001Medicaid
IL0001620960OtherBLUE CROSS BLUE SHIELD
IL344427601-001Medicaid
IL0001620960OtherBLUE CROSS BLUE SHIELD
IL344427601-001Medicaid
ILL84456Medicare UPIN