Provider Demographics
NPI:1881863637
Name:LAKESHORE SURGERY CENTER
Entity Type:Organization
Organization Name:LAKESHORE SURGERY CENTER
Other - Org Name:LAKESHORE LAPAROSCOPIC BARIATRIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAGHU
Authorized Official - Middle Name:
Authorized Official - Last Name:NAYAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-761-6900
Mailing Address - Street 1:7200 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1812
Mailing Address - Country:US
Mailing Address - Phone:773-761-6900
Mailing Address - Fax:
Practice Address - Street 1:7200 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-1812
Practice Address - Country:US
Practice Address - Phone:773-761-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical