Organization
LAKEVIEW HOME DIALYSIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMED MEDHAT SALEM (PRESIDENT)
(773) 525-4701
Entity
Organization
Contact information
Practice address
331 W SURF ST STE 703, CHICAGO, IL 60657-7227
(773) 525-3053
(773) 326-3539
Mailing address
331 W SURF ST STE 703, CHICAGO, IL 60657-7227
(773) 525-4701
(773) 326-3539
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14-2724
CMS CERTIFICATION NUMBER
IL
Enumeration date
04/30/2009
Last updated
04/09/2020
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