# LAKESIDE MEDICAL GROUP LTD

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

## Provider details

- **NPI number:** 1790809804
- **Authorized official:** DR. JAVED NAZIR M.D. (PRESIDENT)
- **Authorized official phone:** (773) 561-5020

## Contact information

- **Practice address:** 1945 W WILSON AVE, SUITE 6119, CHICAGO, IL 60640-5255
- **Practice address phone:** (773) 561-5020
- **Practice address fax:** (773) 561-5635
- **Mailing address:** 1945 W WILSON AVE, SUITE 6119, CHICAGO, IL 60640-5255
- **Mailing address phone:** (773) 561-5020
- **Mailing address fax:** (773) 561-5635

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RA0000X | Adolescent Medicine (Internal Medicine) Physician | — | IL | Yes |

## Other

- **Enumeration date:** 03/16/2007
- **Last updated:** 08/22/2020