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LAKE COUNTY PEDIATRICS SC
NPI 1114102530
Pediatrics in Gurnee, IL

Active since January 03, 2008CLIA 14D0412607 · Waiver
200 S GREENLEAF AVE, SUITE E, GURNEE, IL 60031(847) 336-0770(847) 336-0159 Get Directions Write a Review

NPPES record last updated: January 3, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Lake County Pediatrics Sc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKE COUNTY PEDIATRICS SC (NPI 1114102530) is a healthcare organization registered as a pediatrics in Gurnee, Illinois and active in the NPI registry since January 2008. The organization holds a CLIA Waiver certificate valid through July 25, 2027 and lists Marlene Juco Tanquilut, President, as its authorized official.

NPPES Registry Identity

NPI1114102530
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameLAKE COUNTY PEDIATRICS SC
Location Address200 S GREENLEAF AVE, SUITE EGurnee, IL 60031
Mailing Address200 S Greenleaf Ave, Suite EGurnee, IL 60031 · (847) 336-0770 · Fax (847) 336-0159
Phone(847) 336-0770
Fax(847) 336-0159
Organization SubpartNo
Authorized OfficialMarlene Juco TanquilutPresident · (847) 336-0770
Enumeration DateJanuary 3, 2008
✔ NPI 1114102530 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
200 S GREENLEAF AVE, Gurnee, IL 60031
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D0412607

Lake County Pediatrics Sc · Gurnee, IL
Active · expires Jul 25, 2027
CLIA Number14D0412607
Laboratory TypePhysician Office
Certificate Effective DateJuly 26, 2025
Certificate Expiration DateJuly 25, 2027
Laboratory DirectorMarlene Tanquilut MD
Laboratory Phone(847) 336-0770
Laboratory LocationLake County Pediatrics Sc1 S Greenleaf St, Ste E, Gurnee, IL 60031
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lake County Pediatrics Sc's NPI number?

The NPI number for Lake County Pediatrics Sc is 1114102530. It was assigned to this organization in the NPPES registry on January 3, 2008.

Where is Lake County Pediatrics Sc located?

Lake County Pediatrics Sc is located at 200 S Greenleaf Ave Suite E, Gurnee, IL 60031. The listed phone number is (847) 336-0770.

What is Lake County Pediatrics Sc's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does Lake County Pediatrics Sc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D0412607) is associated with this NPI, valid through July 25, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Lake County Pediatrics Sc was last updated on January 3, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.