Healthcare Provider Details

I. General information

NPI: 1265611438
Provider Name (Legal Business Name): FAMILY PHYSICIANS OF LAKEVIEW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 N ASHLAND AVE
CHICAGO IL
60657-3012
US

IV. Provider business mailing address

3002 N ASHLAND AVE
CHICAGO IL
60657-3012
US

V. Phone/Fax

Practice location:
  • Phone: 773-244-0441
  • Fax:
Mailing address:
  • Phone: 773-244-0441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SARA BRAUNSTEIN BRAUNSTEIN
Title or Position: PRESIDENT
Credential:
Phone: 773-244-0485