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General NPI Number Information
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NPI Number | 1396617361
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Entity Type | Organization
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Legal Business Name | LAKEFRONT MSO LLC
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Dates
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Enumeration Date | 09/19/2025
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 4580 WEAVER PKWY STE 102
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City | WARRENVILLE
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State | IL
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Zip | 60555-3864
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Country | US
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Telephone | 630-839-9199
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Fax | 630-839-9299
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Provider Business Mailing Address
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Address Line | 4580 WEAVER PKWY STE 102
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City | WARRENVILLE
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State | IL
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Zip | 60555-3864
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Country | US
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Telephone | 630-839-9199
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Fax | 630-839-9299
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Authorized Official
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Title or Position | OPERATIONS MANAGER/MBR
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Name | BARBARA RYNIEC
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Credential |
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Telephone | 630-699-5278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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