Organization
LAKE SHORE ADULT & GERIATRIC MEDICINE, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK VEXELMAN MD (PRESIDENT)
(312) 649-6565
Entity
Organization
Contact information
Practice address
150 E HURON STREET, SUITE 805, CHICAGO, IL 60611-2912
(312) 649-6565
(312) 649-9842
Mailing address
150 E HURON STREET, SUITE 805, CHICAGO, IL 60611-2912
(312) 649-6565
(312) 649-9842
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036095873
IL
Other
Enumeration date
08/04/2006
Last updated
04/09/2010
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