Lakeside Medical, Inc.

NPI #1144477738 in Evanston, Illinois

Provider Information

NPI Number: 1144477738
Entity Type: Organization
Organization Name: Lakeside Medical, Inc.
Primary Specialty: Specialist
Enumeration Date: Aug 26, 2008
Last Updated: Aug 26, 2008

Practice Location

Address: 1001 EMERSON ST
Address 2: SUITE 306
City: Evanston
State: Illinois
ZIP Code: 60201-3147
Phone: (847) 209-3729

Authorized Official

Name: MR. JEFF VANTIL
Title: CEO
Phone: (219) 926-5400

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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