Lake Mi Mobile Doctors, P.C.

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

Legal business name

LAKE MI MOBILE DOCTORS, P.C.

Doing business as

Mobile Doctors of Chicago

Practice address

3319 N Elston Ave
Suite 100
Chicago, IL 60618-5811

Phone

(773) 751-7200

Fax

(773) 583-4401

NPI assigned

May 27, 2006

Last updated

Oct 19, 2012By 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. Tysyn Contreras

Title

Director, Quality Assurance

Phone

(312) 939-5090

Specialties & licenses 1

Addresses

Other names 1

• Mobile Doctors of Chicago Doing business as

Locations

Practitioners 2

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.

• Eva Madelyn Conty-Cuevas

  • Family Nurse Practitioner
  • Chicago, IL
  • NPI 1578670428
  NPD (past)
• Glenn Alden Harrison, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Chicago, IL
  • NPI 1316076946
  NPD (past)

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350604800000",
    "number": "1437106465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3319 N ELSTON AVE",
            "address_2": "SUITE 200",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606185811",
            "telephone_number": "773-751-7200",
            "fax_number": "773-583-4401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3319 N ELSTON AVE",
            "address_2": "SUITE 100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606185811",
            "telephone_number": "773-751-7200",
            "fax_number": "773-583-4401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MI MOBILE DOCTORS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2012-10-19",
        "status": "A",
        "authorized_official_last_name": "CONTRERAS",
        "authorized_official_first_name": "TYSYN",
        "authorized_official_title_or_position": "DIRECTOR, QUALITY ASSURANCE",
        "authorized_official_telephone_number": "312-939-5090",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mobile Doctors of Chicago",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Lake Mi Mobile Doctors, P.C. (Mobile Doctors of Chicago Podiatry)
• Lake Michigan Psychotherapy Services, PLLC
• Lake Park Counseling, P.C.
• Lake Shore Adult & Geriatric Medicine, LTD
• Lake Shore Anesthesia Associates, LLC

• Geriatric Medicine (Internal Medicine) Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Geriatric Medicine (Internal Medicine) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2012; 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.