Organization
LAKEVIEW NEUROSURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIN DANETTE JACKSON (OFFICE MANAGER)
(630) 376-6274
Entity
Organization
Contact information
Practice address
246 E. JANATA BLVD, STE 135, LOMBARD, IL 60148
(630) 376-6274
(630) 376-6279
Mailing address
246 E JANATA BLVD, STE 135, LOMBARD, IL 60148
(630) 376-6274
(630) 376-6279
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
036111694
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036111694
—
IL
Enumeration date
08/23/2006
Last updated
06/13/2011
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