Organization
LAKE STREET FAMILY MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN KOECHER D.O. (PHYSICIAN)
(630) 516-0434
Entity
Organization
Contact information
Practice address
220 E LAKE ST, SUITE 100, ADDISON, IL 60101-2887
(630) 516-0434
(630) 516-0419
Mailing address
220 E LAKE ST, SUITE 100, ADDISON, IL 60101-2887
(630) 516-0434
(630) 516-0419
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
02/22/2007
Last updated
12/11/2012
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