Lacrosse, Marilyn M C
Lacrosse, Marilyn M C is an individual health care provider with primary practice located at 360 Station Dr , Crystal Lake IL 60014. She recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Adolescent Medicine, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Lacrosse, Marilyn M C can be contacted via phone (815) 338-6600.Contact Information
Primary practice address
360 Station Dr
Crystal Lake IL 60014
Phone: (815) 338-6600
Fax: (847) 802-7112
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | 44165-020 | Wisconsin |
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | 036119800 | Illinois |
| Allopathic & Osteopathic Physicians / Adolescent Medicine | 2080A0000X | 036-119800 | Illinois |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 036119800 | Illinois |
Profile Details
| NPI number | 1255376885 |
|---|---|
| LBN Legal business name | Lacrosse, Marilyn M C |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 18th, 2006 |
| Last updated | Jun 7th, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1255376885 | NPPES |
| Wisconsin | MEDICAID | 34182500 | |
| Wisconsin | Other | 930116115 | |
| Wisconsin | Other | 036119800 | |
| Wisconsin | Other | P00226727 | |
| Wisconsin | Other | 930123614 |
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