MEDICARE: LAKEVIEW WOMENS HEALTH SC

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	207V00000X	Obstetrics & Gynecology Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01630320	OTHER		BC/BS
2	501046	OTHER		ADVOCATE

General Provider Information

NPI Number	:	1780662585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEVIEW WOMENS HEALTH SC

Provider Business Mailing Address
First Line	:	3000 N HALSTED ST
Second Line	:	STE 720
City	:	CHICAGO
State	:	IL
Zip	:	60657-5188
Country	:	US
Telephone Number	:	773-871-1807
Fax Number	:	773-871-9954

Provider Business Practice Location Address
First Line	:	3000 N HALSTED
Second Line	:	STE 709
City	:	CHICAGO
State	:	IL
Zip	:	60657-5196
Country	:	US
Telephone Number	:	773-871-1807
Fax Number	:	773-871-9954

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ILONA MARIE CARLOS
Credential	:	MD
Telephone Number	:	773-871-1807

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	04/09/2008

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Directions to “LAKEVIEW WOMENS HEALTH SC ” Practice Location

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