Healthcare Provider Details

I. General information

NPI: 1497191662
Provider Name (Legal Business Name): LAKEVIEW PHYSICAL MEDICINE LIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 N LINCOLN AVE SUITE 1
CHICAGO IL
60657-1117
US

IV. Provider business mailing address

3250 N LINCOLN AVE SUITE 1
CHICAGO IL
60657-1117
US

V. Phone/Fax

Practice location:
  • Phone: 773-775-9516
  • Fax: 773-755-9517
Mailing address:
  • Phone: 773-775-9516
  • Fax: 773-755-9517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-008549
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL J DUBICK
Title or Position: PRESIDENT
Credential: D.C.
Phone: 773-755-9516