Provider Demographics
NPI:1093810681
Name:LAKEVIEW DIAGNOSTICS INC
Entity Type:Organization
Organization Name:LAKEVIEW DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AZAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBASI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-910-0193
Mailing Address - Street 1:708 LAVERGNE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2028
Mailing Address - Country:US
Mailing Address - Phone:773-910-0193
Mailing Address - Fax:773-637-2006
Practice Address - Street 1:708 LAVERGNE AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2028
Practice Address - Country:US
Practice Address - Phone:773-910-0193
Practice Address - Fax:773-637-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360647562471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1633943OtherBLUE SHIELD OF IL
IL036064756Medicaid
IL1633943OtherBLUE SHIELD OF IL
IL036064756Medicaid