# KATRINA LAKE MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Live. Love. Wellness MD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013536663
- **Authorized official:** KATRINA LAKE MD (OWNER)
- **Authorized official phone:** (708) 308-8974

## Contact information

- **Practice address:** 18503 BELLAMY RD, COUNTRY CLUB HILLS, IL 60478-5279
- **Practice address phone:** (708) 365-8343
- **Mailing address:** 18503 BELLAMY RD, COUNTRY CLUB HILLS, IL 60478-5279

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/14/2020
- **Last updated:** 05/01/2020