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NPI Code Detail

MEDICARE: CHICAGO LAKE SHORE MEDICAL ASSOCIATES,LTD

MEDICARE: CHICAGO LAKE SHORE MEDICAL ASSOCIATES,LTD
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
1207K00000XAllergy & Immunology Physician
2207N00000XDermatology Physician
3207RC0000XCardiovascular Disease Physician
4207RG0100XGastroenterology Physician
5207RP1001XPulmonary Disease Physician
62084N0400XNeurology Physician
7213E00000XPodiatrist
8261QS1200XSleep Disorder Diagnostic Clinic/Center
9207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1912946120
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHICAGO LAKE SHORE MEDICAL ASSOCIATES,LTD
Provider Business Mailing Address
First Line : 676 N ST CLAIR
Second Line : SUITE 2300
City : CHICAGO
State : IL
Zip : 60611-2922
Country : US
Telephone Number : 312-926-6000
Fax Number : 312-276-4032
Provider Business Practice Location Address
First Line : 676 N ST CLAIR
Second Line : SUITE 2300
City : CHICAGO
State : IL
Zip : 60611-2922
Country : US
Telephone Number : 312-926-6000
Fax Number : 312-276-4032
Authorized Official
Title or Position : PRACTICE MANAGER
Name : MRS. LINDA D MARRA
Credential : CPC
Telephone Number : 312-926-6101
Provider Enumeration Date : 06/05/2006
Last Update Date : 07/23/2012

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