Organization
LAKESHORE GASTROENTEROLOGY AND LIVER DISEASE INSTITUTE S.C.
Active
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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