Healthcare Provider Details

I. General information

NPI: 1073525234
Provider Name (Legal Business Name): LAKEVIEW PULMONARY & SLEEP CONSULTANTS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 W IRVING PARK RD STE 305
CHICAGO IL
60613-3011
US

IV. Provider business mailing address

2180 DE COOK AVE
PARK RIDGE IL
60068-1538
US

V. Phone/Fax

Practice location:
  • Phone: 773-975-6775
  • Fax: 773-975-1089
Mailing address:
  • Phone: 773-505-3071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: VENKATA L BUDDHARAJU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 773-505-3071