| Lakeview Medical & Psychiatric Healthcare Llc | |
|
1601 West Jackson Street Suite 104 Macomb IL 61455 | |
| (309) 575-3222 | |
| (309) 404-8000 |
| Full Name | Lakeview Medical & Psychiatric Healthcare Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1601 West Jackson Street, Macomb, Illinois |
| Authorized Official Name and Position | Michael Paul Bednarz (OWNER) |
| Authorized Official Contact | 7734853222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeview Medical & Psychiatric Healthcare Llc 1601 West Jackson Street Suite 104 Macomb IL 61455 Ph: (309) 575-3222 | Lakeview Medical & Psychiatric Healthcare Llc 1601 West Jackson Street Suite 104 Macomb IL 61455 Ph: (309) 575-3222 |
| NPI Number | 1942656749 |
|---|---|
| Provider Enumeration Date | 05/11/2016 |
| Last Update Date | 11/06/2018 |
| Medicare PECOS PAC ID | 5496049330 |
|---|---|
| Medicare Enrollment ID | O20160816000417 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942656749 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Michael P Bednarz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184661407 PECOS PAC ID: 3375540354 Enrollment ID: I20061106000169 |
| Provider Name | Ashley Mae Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235534066 PECOS PAC ID: 8921324070 Enrollment ID: I20150306002267 |
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