Organization
LAKESIDE MEDICAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFF VANTIL (CEO)
(219) 926-5400
Entity
Organization
Contact information
Practice address
1001 EMERSON ST, SUITE 306, EVANSTON, IL 60201-3147
(847) 209-3729
Mailing address
320 S CALUMET RD, CHESTERTON, IN 46304-2451
(219) 926-5400
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
08/26/2008
Last updated
08/26/2008
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