Provider Demographics
NPI:1346235090
Name:LAKE FRONT MEDICAL CARE INC
Entity Type:Organization
Organization Name:LAKE FRONT MEDICAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-478-9008
Mailing Address - Street 1:PO BOX 18447
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-0447
Mailing Address - Country:US
Mailing Address - Phone:773-478-9008
Mailing Address - Fax:773-478-9717
Practice Address - Street 1:4151 N KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-2409
Practice Address - Country:US
Practice Address - Phone:773-478-9008
Practice Address - Fax:773-478-9717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL0757390001Medicare ID - Type Unspecified