Katrina Lake MD LLC
NPI #1013536663 in Country Club Hills, Illinois
Provider Information
- NPI Number
- 1013536663
- Entity Type
- Organization
- Organization Name
- Katrina Lake MD LLC
- Primary Specialty
- Clinic/Center - Multi-Specialty
- Enumeration Date
- Apr 14, 2020
- Last Updated
- May 1, 2020
Practice Location
- Address
- 18503 BELLAMY RD
- State
- Illinois
- ZIP Code
- 60478-5279
- Phone
- (708) 365-8343
Authorized Official
- Name
- KATRINA LAKE, MD
- Title
- OWNER
- Phone
- (708) 308-8974
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Multi-Specialty — Multi-Specialty |
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