Lake Shore Surgical Associates, LTD.

Primary specialty

SpecialistTaxonomy code 174400000X

License

036060787 Issued in IL

Legal business name

LAKE SHORE SURGICAL ASSOCIATES, LTD.

Practice address

111 N Wabash Ave Ste 1709
Chicago, IL 60602-2989

Phone

(312) 641-1150

Fax

(312) 332-0299

NPI assigned

Nov 30, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Lawrence Mark Krause, MD

Title

President

Phone

(312) 641-1150

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1196380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196380800000",
    "number": "1396927398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1460",
            "city": "HIGHLAND PARK",
            "state": "IL",
            "postal_code": "600357460",
            "telephone_number": "312-641-1150",
            "fax_number": "312-332-0299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 N WABASH AVE STE 1709",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606022989",
            "telephone_number": "312-641-1150",
            "fax_number": "312-332-0299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SHORE SURGICAL ASSOCIATES, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-30",
        "last_updated": "2007-11-30",
        "status": "A",
        "authorized_official_last_name": "KRAUSE",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-641-1150",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "IL",
            "license": "036060787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake Shore Plastic Surgery
• Lake Shore Podiatry Center, LLC
• Lake Shore Podiatry Center, LLC
• Lake Shore Podiatry Center, LLC
• Lake Shore Podiatry Center, LLC
• Lake Shore Therapy Center, Inc.
• Lake View Dental Associates, PC
• Jacob S Lake, DDS
• Jennifer Zang Lake, LPC
• Mary E. Lake, M.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 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.