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General NPI Number Information
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NPI Number | 1114179215
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Entity Type | Organization
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Legal Business Name | LAKE SHORE FOOT & ANKLE, PC
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 04/30/2015
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Provider Practice Location Address
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Address Line | 767 PARK AVE W SUITE 130
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-2400
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Country | US
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Telephone | 847-432-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 2623 N HALSTED ST
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City | CHICAGO
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State | IL
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Zip | 60614-2393
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Country | US
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Telephone | 773-477-3668
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Fax | 773-871-1244
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Authorized Official
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Title or Position | OWNER
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Name | LEE R STEIN
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Credential | DPM
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Telephone | 847-433-4441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016004996
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License Number State | IL
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