Lakeside Medical, Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

LAKESIDE MEDICAL, INC.

Practice address

1001 Emerson St
Suite 306
Evanston, IL 60201-3147

Phone

(847) 209-3729

NPI assigned

Aug 26, 2008

Last updated

Aug 26, 2008By 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

Mr. Jeff Vantil

Title

Ceo

Phone

(219) 926-5400

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1219708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219708800000",
    "number": "1144477738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 S CALUMET RD",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463042451",
            "telephone_number": "219-926-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 EMERSON ST",
            "address_2": "SUITE 306",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602013147",
            "telephone_number": "847-209-3729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE MEDICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-26",
        "last_updated": "2008-08-26",
        "status": "A",
        "authorized_official_last_name": "VANTIL",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "219-926-5400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Sue P Lafferty, PHD
• Joanne Barbara Lagattolla, LCPC
• Lake Shore Gastroenterology
• Lakeside Digestion PLLC
• Lakeside Eye Care & Eye Wear Emporium, LTD.
• Lakeside Oral & Facial Surgery Institute
• Khadija Lakhtir
• Archana Lal-Tabak, MD
• Lamarr Lemee Dental Corp
• Carla F. Lamarr, D.D.S

• Specialist in Evanston, IL
• Providers in Evanston, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2008; 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.