Organization
LAKE SHORE MEDICAL ASSOCIATES, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIJAYALAKSHMI AREKAPUDI M.D. (PRESIDENT)
(773) 525-7720
Entity
Organization
Contact information
Practice address
2222 W DIVISION ST STE 116, CHICAGO, IL 60622-3093
(773) 525-7720
(773) 525-9199
Mailing address
2734 N LINCOLN AVE, CHICAGO, IL 60614-1321
(773) 525-7720
(773) 525-9199
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D5245-919-2
IL CORP FILE NUMBER
IL
Enumeration date
10/08/2005
Last updated
06/03/2016
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