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General NPI Number Information
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NPI Number | 1346235090
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Entity Type | Organization
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Legal Business Name | LAKE FRONT MEDICAL CARE INC
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4151 N KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60618-2409
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Country | US
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Telephone | 773-478-9008
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Fax | 773-478-9717
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Provider Business Mailing Address
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Address Line | PO BOX 18447
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City | CHICAGO
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State | IL
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Zip | 60618-0447
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Country | US
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Telephone | 773-478-9008
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Fax | 773-478-9717
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARL MARTIN BERMAN
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Credential |
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Telephone | 773-478-9008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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