NPIMap

Organization Active NPI

Lakeside Medical Group LTD

  • Adolescent Medicine (Internal Medicine) Physician
  • Chicago, IL
National Provider Identifier
1790809804
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0000X
Legal business name
LAKESIDE MEDICAL GROUP LTD
Practice address
1945 W Wilson Ave
Suite 6119
Chicago, IL 60640-5255
Phone
(773) 561-5020
Fax
(773) 561-5635
NPI assigned
Mar 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Javed Nazir, M.D.
Title
President
Phone
(773) 561-5020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RA0000X IL Primary

Addresses

Primary practice location

1945 W Wilson Ave
Suite 6119
Chicago, IL 60640-5255

Mailing address

1945 W Wilson Ave
Suite 6119
Chicago, IL 60640-5255
Phone (773) 561-5020

National Provider Directory

National Provider Directory

Locations

3553 W Peterson Ave
Ste 105
Chicago, IL 60659
Phone (773) 267-3807

Practitioners & affiliated clinicians

Practitioners 7

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": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790809804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1945 W WILSON AVE",
            "address_2": "SUITE 6119",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405255",
            "telephone_number": "773-561-5020",
            "fax_number": "773-561-5635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1945 W WILSON AVE",
            "address_2": "SUITE 6119",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405255",
            "telephone_number": "773-561-5020",
            "fax_number": "773-561-5635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE MEDICAL GROUP LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NAZIR",
        "authorized_official_first_name": "JAVED",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-561-5020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RA0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Adolescent Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "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 Aug 22, 2020; 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.