NPIMap

Organization Active NPI

Lake Shore Therapy Center, Inc.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Chicago, IL
National Provider Identifier
1538356233
Registry record updated Dec 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
License
036-084312 Issued in IL
Legal business name
LAKE SHORE THERAPY CENTER, INC.
Practice address
2338 W Morse Ave
1 A
Chicago, IL 60645-4767
Phone
(773) 754-0027
Fax
(773) 754-0063
NPI assigned
Sep 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2009

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

Authorized official

Name
Dr. Eliza Diaconescu, M.D.NPI 1881655140
Title
Medical Director
Phone
(773) 754-0027

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X 036-084312 IL Primary
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X 036-084312 IL
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 070013870 IL

Addresses

Primary practice location

2338 W Morse Ave
1 A
Chicago, IL 60645-4767

Mailing address

2338 W Morse Ave
1A
Chicago, IL 60645-4767
Phone (773) 754-0027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1190851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260144000000",
    "number": "1538356233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2338 W MORSE AVE",
            "address_2": "1A",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606454767",
            "telephone_number": "773-754-0027",
            "fax_number": "773-754-0063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2338 W MORSE AVE",
            "address_2": "1 A",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606454767",
            "telephone_number": "773-754-0027",
            "fax_number": "773-754-0063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SHORE THERAPY CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-27",
        "last_updated": "2009-12-07",
        "status": "A",
        "authorized_official_last_name": "DIACONESCU",
        "authorized_official_first_name": "ELIZA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "773-754-0027",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "IL",
            "license": "036-084312",
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "IL",
            "license": "036-084312",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070013870",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2009; 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.