Lakeside Digestion PLLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

LAKESIDE DIGESTION PLLC

Practice address

501 Sherman Ave
Evanston, IL 60202-2815

Phone

(773) 319-7319

NPI assigned

Jan 16, 2020

Last updated

Jan 20, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nicholas Palumbo

Title

Owner

Phone

(224) 900-7562

Specialties & licenses 1

Addresses

Other identifiers 3

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1579132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579478400000",
    "number": "1053941112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 SHERMAN AVE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602022815",
            "telephone_number": "224-900-7562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 SHERMAN AVE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602022815",
            "telephone_number": "773-319-7319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE DIGESTION PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-16",
        "last_updated": "2020-01-20",
        "certification_date": "2020-01-20",
        "status": "A",
        "authorized_official_last_name": "PALUMBO",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "224-900-7562"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RD LICENSE NICHOLAS PALUMBO",
            "identifier": "164005341",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUSINESS LICENSE LAKESIDE DIGESTION",
            "identifier": "248002576",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI NICHOLAS PALUMBO",
            "identifier": "1861701500",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Victoria Quero Lacocque, MSW
• Lauren Marie Ladd, PA-C
• Mary Sue P Lafferty, PHD
• Joanne Barbara Lagattolla, LCPC
• Lake Shore Gastroenterology
• Lakeside Eye Care & Eye Wear Emporium, LTD.
• Lakeside Medical, Inc.
• Lakeside Oral & Facial Surgery Institute
• Khadija Lakhtir
• Archana Lal-Tabak, MD

• Registered Dietitian in Evanston, IL
• Providers in Evanston, IL by specialty
• Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.