Organization
LAKE SHORE THERAPY CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELIZA DIACONESCU M.D. (MEDICAL DIRECTOR)
(773) 754-0027
Entity
Organization
Contact information
Practice address
2338 W MORSE AVE, 1 A, CHICAGO, IL 60645-4767
(773) 754-0027
(773) 754-0063
Mailing address
2338 W MORSE AVE, 1A, CHICAGO, IL 60645-4767
(773) 754-0027
(773) 754-0063
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
036-084312
IL
208VP0014X
Interventional Pain Medicine Physician
036-084312
IL
225100000X
Physical Therapist
070013870
IL
Other
Enumeration date
09/27/2007
Last updated
12/07/2009
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