Provider Demographics
NPI:1588651319
Name:LAKESHORE OBSTETRICS AND GYNECOLOGY LLC
Entity Type:Organization
Organization Name:LAKESHORE OBSTETRICS AND GYNECOLOGY LLC
Other - Org Name:LAKE SHORE OB GYN, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-943-3300
Mailing Address - Street 1:680 N LAKE SHORE DR
Mailing Address - Street 2:SUITE 824
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4546
Mailing Address - Country:US
Mailing Address - Phone:312-943-3300
Mailing Address - Fax:312-266-4591
Practice Address - Street 1:680 N LAKE SHORE DR
Practice Address - Street 2:SUITE 824
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4546
Practice Address - Country:US
Practice Address - Phone:312-943-3300
Practice Address - Fax:312-266-4591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL268871Medicare ID - Type Unspecified