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Organization

LAKE STREET FAMILY PHYSICIANS SC INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
NANCY BELL (PRACTICE MANAGER)
(708) 524-8600
Entity
Organization

Contact information

Practice address
1010 W LAKE ST, SUITE 500, OAK PARK, IL 60301
(708) 524-8600
(708) 524-8147
Mailing address
PO BOX 799, OAK PARK, IL 60303
(708) 524-8600
(708) 524-8147

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
042618366
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01634822
BCBS
IL
01
DD3406
MEDICARE RAILROAD
IL
Enumeration date
11/16/2006
Last updated
02/12/2013
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