| Lake Shore Medical Consultants, S.c. | |
|
2800 N Sheridan Rd Suite 203 Chicago IL 60657-6156 | |
| (773) 404-5263 | |
| (773) 404-1867 |
| Full Name | Lake Shore Medical Consultants, S.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 2800 N Sheridan Rd, Chicago, Illinois |
| Authorized Official Name and Position | Lynda Lane (CEO) |
| Authorized Official Contact | 7734045263 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Shore Medical Consultants, S.c. 2800 N Sheridan Rd Suite 203 Chicago IL 60657-6156 Ph: (773) 404-5263 | Lake Shore Medical Consultants, S.c. 2800 N Sheridan Rd Suite 203 Chicago IL 60657-6156 Ph: (773) 404-5263 |
| NPI Number | 1417021551 |
|---|---|
| Provider Enumeration Date | 11/20/2006 |
| Last Update Date | 01/28/2008 |
| Medicare PECOS PAC ID | 1456488717 |
|---|---|
| Medicare Enrollment ID | O20100420000126 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417021551 | NPI | - | NPPES |
| 0031604330 | Other | IL | BCBS PROVIDER ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Lynda Lane |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982699765 PECOS PAC ID: 8426185687 Enrollment ID: I20100420000193 |
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