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Organization
LAKE SHORE THERAPY CENTER, INC.
Active
Organization
LAKE SHORE THERAPY CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELIZA DIACONESCU M.D. (MEDICAL DIRECTOR)
(773) 754-0027
Entity
Organization
Contact information
Practice address
2338 W MORSE AVE, 1 A, CHICAGO, IL 60645-4767
(773) 754-0027
(773) 754-0063
Mailing address
2338 W MORSE AVE, 1A, CHICAGO, IL 60645-4767
(773) 754-0027
(773) 754-0063
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
036-084312
IL
208VP0014X
Interventional Pain Medicine Physician
036-084312
IL
225100000X
Physical Therapist
070013870
IL
Other
Enumeration date
09/27/2007
Last updated
12/07/2009
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