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General NPI Number Information
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NPI Number | 1497191662
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Entity Type | Organization
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Legal Business Name | LAKEVIEW PHYSICAL MEDICINE LIMITED
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Dates
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Enumeration Date | 05/15/2013
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Last Update Date | 08/05/2013
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Provider Practice Location Address
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Address Line | 3250 N LINCOLN AVE SUITE 1
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City | CHICAGO
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State | IL
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Zip | 60657-1117
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Country | US
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Telephone | 773-775-9516
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Fax | 773-755-9517
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Provider Business Mailing Address
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Address Line | 3250 N LINCOLN AVE SUITE 1
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City | CHICAGO
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State | IL
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Zip | 60657-1117
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Country | US
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Telephone | 773-775-9516
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Fax | 773-755-9517
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL J DUBICK
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Credential | D.C.
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Telephone | 773-755-9516
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038-008549
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License Number State | IL
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