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NPI Code Detail

MEDICARE: LAKEVIEW PEDIATRICS, LLC

MEDICARE: LAKEVIEW PEDIATRICS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101633936OTHERILBCBS PROVIDER ID

General Provider Information

NPI Number : 1700931136
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKEVIEW PEDIATRICS, LLC
Provider Business Mailing Address
First Line : 1333 W BELMONT AVE STE 310
Second Line :
City : CHICAGO
State : IL
Zip : 60657-5785
Country : US
Telephone Number : 773-880-1738
Fax Number : 773-472-7395
Provider Business Practice Location Address
First Line : 1333 W BELMONT AVE STE 310
Second Line :
City : CHICAGO
State : IL
Zip : 60657-5785
Country : US
Telephone Number : 773-880-1738
Fax Number : 773-472-7395
Authorized Official
Title or Position : PHYSICIAN/OWNER
Name : AUDREY CHANG
Credential : M.D.
Telephone Number : 773-880-1738
Provider Enumeration Date : 01/24/2007
Last Update Date : 12/02/2025

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Directions to “LAKEVIEW PEDIATRICS, LLC ” Practice Location

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