Organization
LAKESIDE NEPHROLGOY LTD/PRARIE
Active
Parent organization
LAKESIDE NEPHROLOGY LTD/LOOP
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAKESIDE NEPHROLOGY LTD/LOOP
Authorized official
MR. SHELDON HIRSCH MD (PARTNER)
(312) 913-0110
Entity
Organization
Contact information
Practice address
1717 S WABASH AVE, CHICAGO, IL 60616-1219
(312) 913-0110
(312) 913-9154
Mailing address
1717 S WABASH AVE, CHICAGO, IL 60616-1219
(312) 913-0110
(312) 913-9154
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
36-065928
IL
Other
Enumeration date
07/02/2008
Last updated
07/02/2008
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