Provider Demographics
NPI:1538581012
Name:HARBOR COUNTRY GYNECOLOGY PLLC
Entity type:Organization
Organization Name:HARBOR COUNTRY GYNECOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESKILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-469-0202
Mailing Address - Street 1:545 GROVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-5067
Mailing Address - Country:US
Mailing Address - Phone:847-362-0100
Mailing Address - Fax:847-918-0426
Practice Address - Street 1:225 S WHITTAKER ST
Practice Address - Street 2:
Practice Address - City:NEW BUFFALO
Practice Address - State:MI
Practice Address - Zip Code:49117-1377
Practice Address - Country:US
Practice Address - Phone:269-469-0207
Practice Address - Fax:269-469-7330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301100396207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty