# LAKEVIEW MEDICAL CENTER AND CONSULTANTS, LTD.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114170537
- **Authorized official:** DR. EDGAR AMISTOSO BORDA M.D. (PRESIDENT/MEDICAL DIRECTOR)
- **Authorized official phone:** (773) 528-5851

## Contact information

- **Practice address:** 3046 N. ASHLAND AVE., CHICAGO, IL 60657-3034
- **Practice address phone:** (773) 528-5851
- **Practice address fax:** (773) 528-9790
- **Mailing address:** 3046 N. ASHLAND AVE., CHICAGO, IL 60657-3034
- **Mailing address phone:** (773) 528-5851
- **Mailing address fax:** (773) 528-9790

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/29/2008
- **Last updated:** 10/29/2008