Organization
LAKESIDE ANESTHESIOLOGY, S.C
Active
Parent organization
LAKESIDE ANESTHESIOLOGY, S.C
Other names
1Body4Life
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAKESIDE ANESTHESIOLOGY, S.C
Authorized official
DR. DAVID S. FOOTERMAN MD (PRESIDENT)
(815) 209-2525
Entity
Organization
Contact information
Practice address
761 HIGHGROVE PL, ROCKFORD, IL 61108-2520
(815) 209-2525
Mailing address
2980 N BEVERLY GLEN CIR, SUITE 301, LOS ANGELES, CA 90077-1726
(310) 474-9809
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
—
—
Other
Enumeration date
11/20/2012
Last updated
11/20/2012
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