NPIMap

Organization Active NPI

Lake Shore Gastroenterology

  • Gastroenterology Physician
  • Highland Park, IL
National Provider Identifier
1205952686
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
LAKE SHORE GASTROENTEROLOGY
Practice address
806 Central Ave
Suite 202
Highland Park, IL 60035-5613
Phone
(847) 433-9840
Fax
(847) 433-9842
NPI assigned
Mar 21, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Fred B Rosenberg, MDNPI 1003817180
Title
President
Phone
(847) 244-2960

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X IL Primary

Addresses

Primary practice location

806 Central Ave
Suite 202
Highland Park, IL 60035-5613

Mailing address

20 Tower CT
Suite C
Gurnee, IL 60031-5711
Phone (847) 244-2960

National Provider Directory

National Provider Directory
Tax ID family
Lake Shore Gastroenterology7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

20 Tower Ct
Ste C
Gurnee, IL 60031
Phone (847) 244-2960

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1205952686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 TOWER CT",
            "address_2": "SUITE C",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315711",
            "telephone_number": "847-244-2960",
            "fax_number": "847-244-2986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 CENTRAL AVE",
            "address_2": "SUITE 202",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "600355613",
            "telephone_number": "847-433-9840",
            "fax_number": "847-433-9842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SHORE GASTROENTEROLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROSENBERG",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-244-2960",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Highland Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.