Provider Demographics
NPI:1679056618
Name:EUGENE POMERANETS M.D.S.C.,
Entity type:Organization
Organization Name:EUGENE POMERANETS M.D.S.C.,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHALLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-245-8700
Mailing Address - Street 1:500 PARK AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-6550
Mailing Address - Country:US
Mailing Address - Phone:847-245-8700
Mailing Address - Fax:847-245-8771
Practice Address - Street 1:500 PARK AVE STE 104
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-6550
Practice Address - Country:US
Practice Address - Phone:847-245-8700
Practice Address - Fax:847-245-8771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty