Lake Shore Gastroenterology

NPI 1205952686 - Internal Medicine - 207RG0100X

NPI Details
NPI 1205952686
Enumeration Date 03/21/2007
Last Updated 07/08/2007
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name FRED B FRED
Position PRESIDENT
Phone (847) 433-9840
Fax (847) 433-9842
Practice Location
806 CENTRAL AVE
SUITE 202
HIGHLAND PARK IL, 60035-5613, US
Phone (847) 433-9840
Fax (847) 433-9842
Business Location
20 TOWER CT
SUITE C
GURNEE IL, 60031-5711, US
Phone (847) 244-2960
Fax (847) 244-2986
Toxanomy
Taxonomy Code 207RG0100X
License State
License Number
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According to our database, Lake Shore Gastroenterology NPI is 1205952686, taxonomy code is 207RG0100X Lake Shore Gastroenterology physically located at 806 Central Ave, Highland Park IL, 60035-5613. NPI Number 1033115704 has the healthcare provider type.

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1205952686 NPI number is provided on an as is basis without warranty of any kind. 1205952686 is maintained by the National Plan & Provider Enumeration System. The contents of Lake Shore Gastroenterology are for informational purposes only.