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Organization
LAKE STREET FAMILY PHYSICIANS SC INC
Active
Organization
LAKE STREET FAMILY PHYSICIANS SC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY BELL (PRACTICE MANAGER)
(708) 524-8600
Entity
Organization
Contact information
Practice address
1010 W LAKE ST, SUITE 500, OAK PARK, IL 60301
(708) 524-8600
(708) 524-8147
Mailing address
PO BOX 799, OAK PARK, IL 60303
(708) 524-8600
(708) 524-8147
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
042618366
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01634822
BCBS
IL
01
—
DD3406
MEDICARE RAILROAD
IL
Enumeration date
11/16/2006
Last updated
02/12/2013
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