NPIMap

Organization Active NPI

Lake Shore Gastroenterolgy SC

  • Gastroenterology Physician
  • Gurnee, IL
National Provider Identifier
1215063144
Registry record updated Sep 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
LAKE SHORE GASTROENTEROLGY SC
Practice address
20 Tower CT
Suite C
Gurnee, IL 60031
Phone
(847) 244-6320
Fax
(847) 244-5095
NPI assigned
Feb 26, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2008

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

Authorized official

Name
Michelle L. McKerlie
Title
Administrator
Phone
(847) 244-2960

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0100X Primary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZP0102X

Addresses

Primary practice location

20 Tower CT
Suite C
Gurnee, IL 60031

Mailing address

20 Tower CT
Suite C
Gurnee, IL 60031
Phone (847) 244-6320

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.

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220832000000",
    "number": "1215063144",
    "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": "60031",
            "telephone_number": "847-244-6320",
            "fax_number": "847-244-5095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 TOWER CT",
            "address_2": "SUITE C",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "60031",
            "telephone_number": "847-244-6320",
            "fax_number": "847-244-5095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SHORE GASTROENTEROLGY SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-26",
        "last_updated": "2008-09-08",
        "status": "A",
        "authorized_official_last_name": "MCKERLIE",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "847-244-2960"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gurnee, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 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.