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General NPI Number Information
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NPI Number | 1235774266
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Entity Type | Organization
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Legal Business Name | LAKEFRONT EMERGENCY PHYSICIANS MEDICAL GROUP, S.C.
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Dates
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Enumeration Date | 11/13/2019
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Last Update Date | 11/13/2019
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Provider Practice Location Address
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Address Line | 4646 N MARINE DR
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City | CHICAGO
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State | IL
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Zip | 60640-5759
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Country | US
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Telephone | 877-346-2211
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4174
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City | SAN DIMAS
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State | CA
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Zip | 91773-8174
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN P MARON
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Credential | MD
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Telephone | 925-225-5837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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