Organization
LAKESHORE CLINICAL LLC
Active
Organization
LAKESHORE CLINICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SETU SHAH (CEO)
(224) 310-8328
Entity
Organization
Contact information
Practice address
5411 E STATE ST STE 4, ROCKFORD, IL 61108-2908
(224) 310-8328
Mailing address
7425 NANTUCKET CV, HANOVER PARK, IL 60133-2720
(224) 310-8328
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
02/17/2022
Last updated
02/17/2022
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