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General NPI Number Information
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NPI Number | 1740340686
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Entity Type | Organization
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Legal Business Name | LAKEVIEW FAMILY DOCTORS, LTD
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 04/02/2015
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Provider Practice Location Address
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Address Line | 650 W ALGONQUIN RD
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City | DES PLAINES
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State | IL
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Zip | 60016-5768
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Country | US
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Telephone | 847-593-2890
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Fax | 847-593-2893
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Provider Business Mailing Address
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Address Line | 650 W ALGONQUIN RD
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City | DES PLAINES
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State | IL
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Zip | 60016-5768
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Country | US
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Telephone | 847-593-2890
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Fax | 847-593-2893
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Authorized Official
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Title or Position | PRESIDENT
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Name | GLENN ALLAN WEISS
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Credential | MD
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Telephone | 847-593-2890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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