NPIMap

Organization Active NPI

Lake Shore Gastroenterology

  • Gastroenterology Physician
  • Gurnee, IL
National Provider Identifier
1467578294
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
20 Tower CT
Suite C
Gurnee, IL 60031-5711
Phone
(847) 244-2960
Fax
(847) 244-2986
NPI assigned
Mar 22, 2007
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, DO
Title
President
Phone
(847) 244-2960

Specialties & licenses 1

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

Addresses

Primary practice location

20 Tower CT
Suite C
Gurnee, IL 60031-5711

Mailing address

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0414489Lake Shore Gastroenterology (Dba)20 Tower Court, Ste F, Gurnee, IL 60031Certificate of waiverAug 31, 2026

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.

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": "1467578294",
    "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": "20 TOWER CT",
            "address_2": "SUITE C",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315711",
            "telephone_number": "847-244-2960",
            "fax_number": "847-244-2986"
        }
    ],
    "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 Gurnee, 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.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.