NPIMap

Organization Active NPI

Lake Shore Gastroenterology

  • Gastroenterology Physician
  • Skokie, IL
National Provider Identifier
1275659187
Registry record updated Aug 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
LAKE SHORE GASTROENTEROLOGY
Practice address
9700 Kenton Ave
Suite 100
Skokie, IL 60076-1259
Phone
(847) 433-9840
Fax
(847) 433-9842
NPI assigned
Mar 22, 2007
Last updated
Aug 27, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2007

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

Authorized official

Name
Walter Reid Glaws, DONPI 1104828532
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

9700 Kenton Ave
Suite 100
Skokie, IL 60076-1259

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.

Practitioners & affiliated clinicians

Practitioners 1

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": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188172800000",
    "number": "1275659187",
    "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": "9700 KENTON AVE",
            "address_2": "SUITE 100",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600761259",
            "telephone_number": "847-433-9840",
            "fax_number": "847-433-9842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SHORE GASTROENTEROLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2007-08-27",
        "status": "A",
        "authorized_official_last_name": "GLAWS",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "REID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-244-2960",
        "authorized_official_credential": "DO"
    },
    "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 Skokie, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2007; 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.