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Organization
LAKESHORE PREMIUM HEALTHCARE, INC
Active
Organization
LAKESHORE PREMIUM HEALTHCARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JULIE THOMAS MD (PHYSICIAN)
(949) 584-2059
Entity
Organization
Contact information
Practice address
3000 N HALSTED ST, SUITE 609, CHICAGO, IL 60657-5188
(949) 584-2059
(949) 679-9174
Mailing address
3000 N HALSTED ST, SUITE 609, CHICAGO, IL 60657-5188
(949) 584-2059
(949) 679-9174
Taxonomy
Speciality
Code
Description
License number
State
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
036-131263
IL
2084P0800X
Psychiatry Physician
036-131263
IL
Other
Enumeration date
10/01/2012
Last updated
10/08/2012
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