Provider Demographics
NPI:1538204961
Name:PALATINE INTERNAL MEDICINE SC
Entity type:Organization
Organization Name:PALATINE INTERNAL MEDICINE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:A
Authorized Official - Last Name:LESNIAUSKAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-359-3363
Mailing Address - Street 1:855 E PALATINE ROAD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074
Mailing Address - Country:US
Mailing Address - Phone:847-359-3363
Mailing Address - Fax:847-359-3904
Practice Address - Street 1:855 E PALATINE ROAD
Practice Address - Street 2:SUITE 250
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074
Practice Address - Country:US
Practice Address - Phone:847-359-3363
Practice Address - Fax:847-359-3904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C39470Medicare UPIN
605500Medicare ID - Type Unspecified