Lakeside Oral & Implant Surgery Institute, PC
Organization Active NPI Oral and Maxillofacial Surgery Clinic/Center · Chicago, IL
NPI 1679070189 · NPPES record last updated Apr 11, 2018
Key facts
- NPI
- 1679070189
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Oral and Maxillofacial Surgery Clinic/Center 261QS0112X
- License
- 021002718 (IL)
- Legal business name
- LAKESIDE ORAL & IMPLANT SURGERY INSTITUTE, PC
- Practice address
- 5758 S Maryland Ave # 4H
Chicago, IL 60637-1426 - Phone
- (773) 702-1865
- Fax
- (773) 834-3888
- NPI assigned
- Apr 11, 2018
- Organization subpart
- No
Authorized official
- Name
- Alan Harvey, DMD
- Title
- Oral & Maxillofacial Surgeon
- Phone
- (773) 702-1865
Practitioners 6
-
Alan Andreas Harvey, D.M.D.
-
Matthew Gregory McKnight, D.D.S., M.D.
-
Michael Alexander, DMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180430002028 | IL | Part B Supplier - Clinic/Group Practice | 8022372903 |
Receives reassigned benefits from 1 practitioner Practice locations: Chicago, IL; Winnetka, IL |
National Provider Directory
Locations
5758 S Maryland Ave
#4H
Chicago, IL 60637
Phone (773) 702-1865
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery Clinic/Center | 261QS0112X | 021002718 | IL | Yes |
Addresses
Primary practice location
5758 S Maryland Ave # 4H
Chicago, IL 60637-1426
Mailing address
5841 S Maryland Ave # Mc9020
Chicago, IL 60637-1443
Phone (773) 702-1865
Other providers in Chicago, IL
- Lakeside Eye Group, S.C.
- Lakeside Medical Group LTD
- Lakeside Nephrolgoy LTD/Prarie
- Lakeside Nephrology, LTD.
- Lakeside Nephrology, LTD.
- Lakeside Psychiatry
- Lakeside Radiologists, SC
- Lakeside Specialized Pediatric Occupational Therapy PLLC
- Lakeside Spine and Wellness Inc
- Lakeview Anesthesia LLC
All providers in Chicago, IL · Oral and Maxillofacial Surgery Clinic/Center in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 11, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.