MEDICARE: LAKESHORE HOME VISITING PHYSICIANS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1063152734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKESHORE HOME VISITING PHYSICIANS

Provider Business Mailing Address
First Line	:	5232 N SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2513
Country	:	US
Telephone Number	:	773-654-3326
Fax Number	:

Provider Business Practice Location Address
First Line	:	5232 N SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2513
Country	:	US
Telephone Number	:	773-654-3326
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	ARNETTE MCKENZIE
Credential	:
Telephone Number	:	773-654-3326

Provider Enumeration Date	:	03/31/2022
Last Update Date	:	01/02/2023

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