Provider Demographics
NPI:1346659596
Name:LAKESHORE HEART & VASCULAR SPECIALISTS
Entity Type:Organization
Organization Name:LAKESHORE HEART & VASCULAR SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMIL
Authorized Official - Middle Name:B
Authorized Official - Last Name:DIHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-336-1600
Mailing Address - Street 1:3915 OGLESBY AVE
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3358
Mailing Address - Country:US
Mailing Address - Phone:847-336-1600
Mailing Address - Fax:
Practice Address - Street 1:3915 OGLESBY AVE
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031
Practice Address - Country:US
Practice Address - Phone:847-336-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036124341207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty