# LAKE SHORE THERAPY CENTER, INC.

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

## Provider details

- **NPI number:** 1538356233
- **Authorized official:** DR. ELIZA DIACONESCU M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (773) 754-0027

## Contact information

- **Practice address:** 2338 W MORSE AVE, 1 A, CHICAGO, IL 60645-4767
- **Practice address phone:** (773) 754-0027
- **Practice address fax:** (773) 754-0063
- **Mailing address:** 2338 W MORSE AVE, 1A, CHICAGO, IL 60645-4767
- **Mailing address phone:** (773) 754-0027
- **Mailing address fax:** (773) 754-0063

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | 036-084312 | IL | Yes |
| 208VP0014X | Interventional Pain Medicine Physician | 036-084312 | IL | — |
| 225100000X | Physical Therapist | 070013870 | IL | — |

## Other

- **Enumeration date:** 09/27/2007
- **Last updated:** 12/07/2009