Provider Demographics
NPI:1114170537
Name:LAKEVIEW MEDICAL CENTER AND CONSULTANTS, LTD.
Entity Type:Organization
Organization Name:LAKEVIEW MEDICAL CENTER AND CONSULTANTS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:AMISTOSO
Authorized Official - Last Name:BORDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-528-5851
Mailing Address - Street 1:3046 N. ASHLAND AVE.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3034
Mailing Address - Country:US
Mailing Address - Phone:773-528-5851
Mailing Address - Fax:773-528-9790
Practice Address - Street 1:3046 N. ASHLAND AVE.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3034
Practice Address - Country:US
Practice Address - Phone:773-528-5851
Practice Address - Fax:773-528-9790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty