Provider Demographics
NPI:1497191662
Name:LAKEVIEW PHYSICAL MEDICINE LIMITED
Entity Type:Organization
Organization Name:LAKEVIEW PHYSICAL MEDICINE LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUBICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-755-9516
Mailing Address - Street 1:3250 N LINCOLN AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1117
Mailing Address - Country:US
Mailing Address - Phone:773-775-9516
Mailing Address - Fax:773-755-9517
Practice Address - Street 1:3250 N LINCOLN AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1117
Practice Address - Country:US
Practice Address - Phone:773-775-9516
Practice Address - Fax:773-755-9517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008549111N00000X
207R00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL8667Medicare PIN