Provider Demographics
NPI:1780662585
Name:LAKEVIEW WOMENS HEALTH SC
Entity type:Organization
Organization Name:LAKEVIEW WOMENS HEALTH SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ILONA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CARLOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-871-1807
Mailing Address - Street 1:3000 N HALSTED ST
Mailing Address - Street 2:STE 720
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5188
Mailing Address - Country:US
Mailing Address - Phone:773-871-1807
Mailing Address - Fax:773-871-9954
Practice Address - Street 1:3000 N HALSTED
Practice Address - Street 2:STE 709
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5196
Practice Address - Country:US
Practice Address - Phone:773-871-1807
Practice Address - Fax:773-871-9954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
01630320OtherBC/BS
501046OtherADVOCATE
501046OtherADVOCATE
H42347Medicare UPIN