LAKE STREET FAMILY MEDICINE LLC NPI 1639204613

NPI Information

LAKE STREET FAMILY MEDICINE, LLC is a family medicine in Addison, IL. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. LAKE STREET FAMILY MEDICINE, LLC NPI is 1639204613. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

220 E LAKE ST
SUITE 100
ADDISON, IL
ZIP 60101-887
Phone: (630) 516-0434
Fax: (630) 516-0419

The provider's authorized official is Brian Koecher .
The authorized official title is Physician and has the following contact phone number (630) 516-0434.

The CLIA number assigned to this NPI record is 14D1046442 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/22/2007 and was last updated on 12/11/2012.

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:

Other Identifiers

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