Lakeside Nephrolgoy LTD/Prarie
Organization Active NPI Specialist · Chicago, IL
NPI 1649433376 · NPPES record last updated Jul 2, 2008
Key facts
- NPI
- 1649433376
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- License
- 36-065928 (IL)
- Legal business name
- LAKESIDE NEPHROLGOY LTD/PRARIE
- Practice address
- 1717 S Wabash Ave
Chicago, IL 60616-1219 - Phone
- (312) 913-0110
- Fax
- (312) 913-9154
- NPI assigned
- Jul 2, 2008
- Organization subpart
- Yes
- Parent organization (as reported)
- LAKESIDE NEPHROLOGY LTD/LOOP
Authorized official
- Name
- Mr. Sheldon Hirsch, MD
- Title
- Partner
- Phone
- (312) 913-0110
Corporate family (same tax ID) 3
National Provider Directory
- Tax ID family
- Lakeside Nephrolgoy Ltdprarie
- Part of
- Lakeside Nephrolgoy Ltdprarie
Locations
1717 S Wabash Ave
Chicago, IL 60616
Phone (312) 913-0000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | 36-065928 | IL | Yes |
Addresses
Primary practice location
1717 S Wabash Ave
Chicago, IL 60616-1219
Mailing address
1717 S Wabash Ave
Chicago, IL 60616-1219
Phone (312) 913-0110
Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 2, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.