Organization
FAMILY PHYSICIANS OF LAKEVIEW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARA BRAUNSTEIN BRAUNSTEIN (PRESIDENT)
(773) 244-0485
Entity
Organization
Contact information
Practice address
3002 N ASHLAND AVE, CHICAGO, IL 60657-3012
(773) 244-0441
Mailing address
3002 N ASHLAND AVE, CHICAGO, IL 60657-3012
(773) 244-0441
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360521124
—
IL
Enumeration date
10/24/2007
Last updated
09/14/2010
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