SAMUEL SOLOMON LAKE M.D. NPI 1154784387

NPI Information

NPI: 1154784387
Provider Name: SAMUEL SOLOMON LAKE, M.D.
Classification:
Entity Type: Individual

PECOS Registration: Yes

Address:
1110 W SCHICK RD
BARTLETT, IL
ZIP 60103
Phone: (630) 372-1100
Get Directions

Samuel Solomon Lake, M.D. is a healthcare provider in Bartlett, IL. Samuel Solomon Lake, M.D. NPI is 1154784387. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: CHICAGO COLLEGE OF MEDICINE AND SURGERY
Graduation Year:2016

The provider's business location address is:

1110 W SCHICK RD
BARTLETT, IL
ZIP 60103-007
Phone: (630) 372-1100
Fax: (630) 372-6230

The NPI 1154784387 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 4/4/2016 and was last updated on 10/5/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207X00000X	Orthopaedic Surgery		75442	WISCONSIN	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	036.160356	OTHER	ILLINOIS	ILLINOIS MEDICAL LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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