Healthcare Provider Details

I. General information

NPI: 1588651319
Provider Name (Legal Business Name): LAKESHORE OBSTETRICS AND GYNECOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DR SUITE 824
CHICAGO IL
60611-4546
US

IV. Provider business mailing address

680 N LAKE SHORE DR SUITE 824
CHICAGO IL
60611-4546
US

V. Phone/Fax

Practice location:
  • Phone: 312-943-3300
  • Fax: 312-266-4591
Mailing address:
  • Phone: 312-943-3300
  • Fax: 312-266-4591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JULIE BARTON
Title or Position: PHYSICIAN
Credential: MD
Phone: 312-943-3300