Healthcare Provider Details

I. General information

NPI: 1104773589
Provider Name (Legal Business Name): LAKEFRONT MEDICAL PARTNERS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 W HIGGINS RD
ROSEMONT IL
60018-4974
US

IV. Provider business mailing address

9400 W HIGGINS RD
ROSEMONT IL
60018-4974
US

V. Phone/Fax

Practice location:
  • Phone: 312-265-4792
  • Fax:
Mailing address:
  • Phone: 312-265-4792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN SNIPES
Title or Position: OWNER
Credential:
Phone: 213-827-3038