Organization
LAKESHORE PULMONARY ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN BEARD M.D. (MEMBER)
(312) 850-1990
Entity
Organization
Contact information
Practice address
2555 S KING DR, 2ND FLOOR, CHICAGO, IL 60616-2419
(312) 674-4005
(312) 674-4001
Mailing address
826 S BELL AVE, CHICAGO, IL 60612-4257
(312) 850-1990
(312) 455-9365
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
036059554
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036059554
—
IL
Enumeration date
02/21/2007
Last updated
07/28/2009
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