Healthcare Provider Details

I. General information

NPI: 1780662585
Provider Name (Legal Business Name): LAKEVIEW WOMENS HEALTH SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N HALSTED STE 709
CHICAGO IL
60657-5196
US

IV. Provider business mailing address

3000 N HALSTED ST STE 720
CHICAGO IL
60657-5188
US

V. Phone/Fax

Practice location:
  • Phone: 773-871-1807
  • Fax: 773-871-9954
Mailing address:
  • Phone: 773-871-1807
  • Fax: 773-871-9954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: ILONA MARIE CARLOS
Title or Position: PRESIDENT
Credential: MD
Phone: 773-871-1807