Unknown Individual – Internal Medicine Physician, NPI 1629064357

Unknown Individual is a healthcare provider. based in Gurnee, Illinois. specializing in Internal Medicine Physician. They hold a License No. 36-053570 (IL). The NPI Number for Unknown Individual is 1629064357

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1629064357
Phone
(847) 623-3200
Address
45 TOWER CT
Deactivation Date
18 August 2021
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 45, Tower Court, Gurnee, Lake County, Illinois, 60031, United States

    SUITE C

    GURNEE, IL 600313376

    Phone: (847) 623-3200

    Fax: (847) 623-9168

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 60031)

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Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1629064357?
NPI 1629064357 belongs to Unknown Individual; compare other details if you need extra assurance.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Internal Medicine Physician in the directory — Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Gurnee?
Public fields place Unknown Individual around Gurnee, Illinois. Always confirm the exact site before visiting.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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