Organization
LAKESHORE GASTROENTEROLOGY AND LIVER DISEASE INSTITUTE S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAMRAN HEYDARPOUR M.D. (OWNER)
(708) 763-8248
Entity
Organization
Contact information
Practice address
1 ERIE COURT, SUITE 3100, OAK PARK, IL 60614-8542
(708) 763-8248
(708) 383-7875
Mailing address
PO BOX 14905, CHICAGO, IL 60614-8542
(708) 763-8248
(708) 383-7875
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
336-052655
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036091055
—
IL
Enumeration date
02/21/2008
Last updated
11/26/2014
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