Organization
LAKESHORE WOMENS HEALTH SPECIALISTS SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSE DIAKOS MD (PARTNER)
(773) 472-1444
Entity
Organization
Contact information
Practice address
1460 N HALSTED, SUITE 503, CHICAGO, IL 60642-2613
(773) 472-1444
(773) 472-4424
Mailing address
1460 N HALSTED, SUITE 503, CHICAGO, IL 60642-2613
(773) 472-1444
(773) 472-4424
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1620171
BLUE CROSS BLUE SHIELD
IL
Enumeration date
06/25/2006
Last updated
01/06/2010
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