Provider Demographics
NPI:1740340686
Name:LAKEVIEW FAMILY DOCTORS, LTD
Entity type:Organization
Organization Name:LAKEVIEW FAMILY DOCTORS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-593-2890
Mailing Address - Street 1:650 W ALGONQUIN RD
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-5768
Mailing Address - Country:US
Mailing Address - Phone:847-593-2890
Mailing Address - Fax:847-593-2893
Practice Address - Street 1:650 W ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-5768
Practice Address - Country:US
Practice Address - Phone:847-593-2890
Practice Address - Fax:847-593-2893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F66126Medicare UPIN
209197Medicare ID - Type Unspecified