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Organization

BETHANY HOMES AND METHODIST HOSPITAL

Active
Other names
LAKEVIEW MEDICAL GROUP
Organization subpart
No

Provider details

NPI number
Authorized official
MR. HAROLD MARSHALL REISLER (CONTROLLER)
(773) 989-1465
Entity
Organization

Contact information

Practice address
5025 N PAULINA ST, CHICAGO, IL 60640-2772
(773) 989-1465
(773) 989-1377
Mailing address
5025 N PAULINA ST, CHICAGO, IL 60640-2772

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary

Other

Enumeration date
11/12/2009
Last updated
11/12/2009
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