# LAKESHORE HOSPITALIST LLC

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

## Provider details

- **NPI number:** 1891113130
- **Authorized official:** PRATEEK MISHRA M.D. (PRESIDENT)
- **Authorized official phone:** (414) 530-5082

## Contact information

- **Practice address:** 850 W IRVING PARK RD, CHICAGO, IL 60613-3099
- **Practice address phone:** (414) 530-5082
- **Mailing address:** 30 OLIVE ST, SUITE 1, GREENFIELD, MA 01301-3318

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 036-118929 | IL | Yes |

## Other

- **Enumeration date:** 04/03/2014
- **Last updated:** 04/03/2014