MEDICARE: LAKESHORE OBSTETRICS AND GYNECOLOGY LLC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1588651319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKESHORE OBSTETRICS AND GYNECOLOGY LLC

Provider Business Mailing Address
First Line	:	680 N LAKE SHORE DR
Second Line	:	SUITE 824
City	:	CHICAGO
State	:	IL
Zip	:	60611-4546
Country	:	US
Telephone Number	:	312-943-3300
Fax Number	:	312-266-4591

Provider Business Practice Location Address
First Line	:	680 N LAKE SHORE DR
Second Line	:	SUITE 824
City	:	CHICAGO
State	:	IL
Zip	:	60611-4546
Country	:	US
Telephone Number	:	312-943-3300
Fax Number	:	312-266-4591

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	JULIE BARTON
Credential	:	MD
Telephone Number	:	312-943-3300

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	12/29/2015

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