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NPI Code Detail

MEDICARE: LAKESHORE SURGERY CENTER

MEDICARE: LAKESHORE SURGERY CENTER
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
1261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1881863637
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKESHORE SURGERY CENTER
Provider Business Mailing Address
First Line : 7200 N WESTERN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60645-1812
Country : US
Telephone Number : 773-761-6900
Fax Number :
Provider Business Practice Location Address
First Line : 7200 N WESTERN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60645-1812
Country : US
Telephone Number : 773-761-6900
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : RAGHU NAYAK
Credential :
Telephone Number : 773-761-6900
Provider Enumeration Date : 02/26/2008
Last Update Date : 02/26/2008

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Directions to “LAKESHORE SURGERY CENTER ” Practice Location

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