Lakeshore Clinical LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

LAKESHORE CLINICAL LLC

Practice address

5411 E State St Ste 4
Rockford, IL 61108-2908

Phone

(224) 310-8328

NPI assigned

Feb 17, 2022

Organization subpart

No

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

Authorized official

Name

Setu ShahNPI 1902554843

Title

Ceo

Phone

(224) 310-8328

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Setu Shah

  • Technician
  • Rockford, IL
  • NPI 1902554843
  NPD Authorized official
• Jacob M Saiger

  • Technician
  • Rockford, IL
  • NPI 1295482982
  NPD

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

{
    "created_epoch": "1645056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645056000000",
    "number": "1124773130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7425 NANTUCKET CV",
            "city": "HANOVER PARK",
            "state": "IL",
            "postal_code": "601332720",
            "telephone_number": "224-310-8328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5411 E STATE ST STE 4",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082908",
            "telephone_number": "224-310-8328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE CLINICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-17",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-15",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "SETU",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "224-310-8328"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenna Lafferty
• David Laib, MD
• Helen Wiedemer Laib, MD
• Lake County Physicians Association
• Abigail Diane Lake, DNP, PMHNP-BC
• Lakeside Anesthesiology, S.C
• Lakeside Anesthesiology, SC
• Radhikaben Lakhani
• June Upshaw Lallas, DDS
• Gabrielle Lalor, LPC

• All providers in Rockford, IL
• Clinical Medical Laboratory in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2022; 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.