Organization
LAKE SHORE MEDICAL CONSULTANTS, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNDA LANE MD (CEO)
(773) 404-5263
Entity
Organization
Contact information
Practice address
2800 N SHERIDAN RD, SUITE 203, CHICAGO, IL 60657-6156
(773) 404-5263
(773) 404-1867
Mailing address
2800 N SHERIDAN RD, SUITE 203, CHICAGO, IL 60657-6156
(773) 404-5263
(773) 404-1867
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0031604330
BCBS PROVIDER ID
IL
Enumeration date
11/20/2006
Last updated
01/28/2008
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