MEDICARE: LAKEVIEW PHYSICAL MEDICINE LIMITED

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	207R00000X	Internal Medicine Physician
2	208100000X	Physical Medicine & Rehabilitation Physician
3	111N00000X	Chiropractor	038-008549	IL

General Provider Information

NPI Number	:	1497191662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEVIEW PHYSICAL MEDICINE LIMITED

Provider Business Mailing Address
First Line	:	3250 N LINCOLN AVE
Second Line	:	SUITE 1
City	:	CHICAGO
State	:	IL
Zip	:	60657-1117
Country	:	US
Telephone Number	:	773-775-9516
Fax Number	:	773-755-9517

Provider Business Practice Location Address
First Line	:	3250 N LINCOLN AVE
Second Line	:	SUITE 1
City	:	CHICAGO
State	:	IL
Zip	:	60657-1117
Country	:	US
Telephone Number	:	773-775-9516
Fax Number	:	773-755-9517

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL J DUBICK
Credential	:	D.C.
Telephone Number	:	773-755-9516

Provider Enumeration Date	:	05/15/2013
Last Update Date	:	08/05/2013

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Directions to “LAKEVIEW PHYSICAL MEDICINE LIMITED ” Practice Location

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