Organization
LAKE SHORE MEDICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BONNIE E. WISE M.D. (DIRECTOR)
(312) 654-5583
Entity
Organization
Contact information
Practice address
680 N LAKE SHORE DR, SUITE 115, CHICAGO, IL 60611-4546
(312) 654-5583
(312) 654-5580
Mailing address
680 N LAKE SHORE DR, SUITE 115, CHICAGO, IL 60611-4546
(312) 654-5583
(312) 654-5580
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
11/15/2006
Last updated
08/22/2020
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