Healthcare Provider Details

I. General information

NPI: 1144418633
Provider Name (Legal Business Name): LAKEFRONT MEDICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 N MARINE DR
CHICAGO IL
60640-5759
US

IV. Provider business mailing address

20 BURTON HILLS BLVD
NASHVILLE TN
37215-6197
US

V. Phone/Fax

Practice location:
  • Phone: 773-564-5102
  • Fax: 773-564-5101
Mailing address:
  • Phone: 615-665-6000
  • Fax: 615-665-6184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: CRAIG C. ARMIN
Title or Position: VP OF GOVT PROGRAMS, TENET
Credential:
Phone: 818-436-2267