Organization
LAKE SHORE PEDIATRICS, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIANE WHEELER FONDRIEST MD (MANAGING PARTNER)
(847) 615-4654
Entity
Organization
Contact information
Practice address
900 N WESTMORELAND RD, SUITE 106, LAKE FOREST, IL 60045-1674
(847) 615-4654
(847) 615-1708
Mailing address
900 N WESTMORELAND RD, SUITE 106, LAKE FOREST, IL 60045-1674
(847) 615-4654
(847) 615-1708
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
36065837
IL
Other
Enumeration date
06/15/2007
Last updated
08/22/2020
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