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General NPI Number Information
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NPI Number | 1033361647
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Entity Type | Organization
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Legal Business Name | LS MEDICAL GROUP,L.L.C.
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Dates
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Enumeration Date | 10/14/2008
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Last Update Date | 10/25/2008
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Provider Practice Location Address
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Address Line | 1515 E LAKE ST SUITE 208
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City | HANOVER PARK
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State | IL
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Zip | 60133-4896
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Country | US
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Telephone | 312-576-3678
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Fax | 866-401-3217
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Provider Business Mailing Address
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Address Line | 3 LAMBETH CT
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City | OAK BROOK
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State | IL
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Zip | 60523-1723
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Country | US
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Telephone | 312-576-3678
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Fax | 866-401-3217
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SARADA DESHPANDE
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Credential | MD
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Telephone | 312-576-3678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036093798
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License Number State | IL
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