Provider Demographics
NPI:1740568351
Name:LAKEVIEW FAMILY MEDICAL CARE LLC
Entity Type:Organization
Organization Name:LAKEVIEW FAMILY MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANSOUR
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALSHOBAKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-424-9900
Mailing Address - Street 1:8014 KIRKCALDY CT
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2768
Mailing Address - Country:US
Mailing Address - Phone:708-424-9900
Mailing Address - Fax:708-424-9901
Practice Address - Street 1:7350 W COLLEGE DR STE 201
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1190
Practice Address - Country:US
Practice Address - Phone:708-424-9900
Practice Address - Fax:708-424-9901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-31
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036125844207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty