MEDICARE: LAKE FRONT MEDICAL CARE INC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1346235090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE FRONT MEDICAL CARE INC

Provider Business Mailing Address
First Line	:	PO BOX 18447
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-0447
Country	:	US
Telephone Number	:	773-478-9008
Fax Number	:	773-478-9717

Provider Business Practice Location Address
First Line	:	4151 N KEDZIE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-2409
Country	:	US
Telephone Number	:	773-478-9008
Fax Number	:	773-478-9717

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CARL MARTIN BERMAN
Credential	:
Telephone Number	:	773-478-9008

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	08/22/2020

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Directions to “LAKE FRONT MEDICAL CARE INC ” Practice Location

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