Lake Shore Pediatrics, Ltd

NPI #1003011628 in Lake Forest, Illinois

Provider Information

NPI Number: 1003011628
Entity Type: Organization
Organization Name: Lake Shore Pediatrics, Ltd
Primary Specialty: Pediatrics
Enumeration Date: Jun 15, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 900 N WESTMORELAND RD
Address 2: SUITE 106
City: Lake Forest
State: Illinois
ZIP Code: 60045-1674
Phone: (847) 615-4654

Authorized Official

Name: DR. DIANE WHEELER FONDRIEST, MD
Title: MANAGING PARTNER
Phone: (847) 615-4654

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pediatrics	208000000X	Primary

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