Provider Demographics
NPI:1790809804
Name:LAKESIDE MEDICAL GROUP LTD
Entity Type:Organization
Organization Name:LAKESIDE MEDICAL GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVED
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-561-5020
Mailing Address - Street 1:1945 W WILSON AVE
Mailing Address - Street 2:SUITE 6119
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5255
Mailing Address - Country:US
Mailing Address - Phone:773-561-5020
Mailing Address - Fax:773-561-5635
Practice Address - Street 1:1945 W WILSON AVE
Practice Address - Street 2:SUITE 6119
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5255
Practice Address - Country:US
Practice Address - Phone:773-561-5020
Practice Address - Fax:773-561-5635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Multi-Specialty