Provider Demographics
NPI:1942656749
Name:LAKEVIEW MEDICAL & PSYCHIATRIC HEALTHCARE LLC
Entity Type:Organization
Organization Name:LAKEVIEW MEDICAL & PSYCHIATRIC HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BEDNARZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-485-3222
Mailing Address - Street 1:1601 WEST JACKSON STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455
Mailing Address - Country:US
Mailing Address - Phone:309-575-3222
Mailing Address - Fax:309-404-8000
Practice Address - Street 1:1601 WEST JACKSON STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455
Practice Address - Country:US
Practice Address - Phone:309-575-3222
Practice Address - Fax:309-404-8000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty