Organization
LAKE SHORE CARDIOLOGY GROUP, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID I KOENIGSBERG M.D. (PRESIDENT)
(312) 854-0031
Entity
Organization
Contact information
Practice address
233 E ERIE ST, SUITE 500, CHICAGO, IL 60611-2926
(312) 854-0031
(312) 255-1245
Mailing address
233 E ERIE ST, SUITE 500, CHICAGO, IL 60611-2926
(312) 854-0031
(312) 255-1245
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1617522
BC BS PROVIDER NUMBER
IL
01
—
234690
HARMONY HEALTH
IL
01
—
CL4625
RAILROAD MEDICARE
IL
Enumeration date
09/28/2006
Last updated
03/02/2016
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