Healthcare Provider Details

I. General information

NPI: 1700931136
Provider Name (Legal Business Name): LAKEVIEW PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 W BELMONT AVE STE 310
CHICAGO IL
60657-5785
US

IV. Provider business mailing address

1333 W BELMONT AVE STE 310
CHICAGO IL
60657-5785
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-1738
  • Fax: 773-472-7395
Mailing address:
  • Phone: 773-880-1738
  • Fax: 773-472-7395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: AUDREY CHANG
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 773-880-1738