LAKESIDE MEDICAL GROUP LTD (NPI# 1790809804) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790809804 |
| Entity Type | Organization |
| Organization Name | LAKESIDE MEDICAL GROUP LTD |
| Practice Address |
1945 W Wilson Ave Suite 6119 Chicago IL 60640-5255 |
| Practice Telephone | 7735615020 |
| Practice Fax Number | 7735615635 |
| Mailing Telephone | 7735615020 |
| Mailing Fax Number | 7735615635 |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. JAVED NAZIR (PRESIDENT) |
| Authorized Official Telephone | 7735615020 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RA0000X |
Internal Medicine Specialization: Adolescent Medicine |
IL | Allopathic & Osteopathic Physicians |
| Street Address |
1945 W WILSON AVE SUITE 6119 |
| City | CHICAGO |
| State | IL |
| Zip Code | 60640-5255 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639160658 | Larry Alan Fisher | Dentist | 1945 W Wilson Ave, Suite 2112, Chicago, IL 60640-5255 | 2005-10-31 |
| 1710519921 | Claire Husaynu | Occupational Therapist | 1945 W Wilson Ave, Chicago, IL 60640-5255 | 2020-02-05 |
| 1700425378 | Kimberly A George | Occupational Therapist | 1945 W Wilson Ave, Chicago, IL 60640-5255 | 2019-12-31 |
| 1790337228 | Tomasa Valencia | Nurse Practitioner | 1945 W Wilson Ave, Chicago, IL 60640 | 2019-07-15 |
| 1417489311 | Laura Therese Toscano | Hearing Instrument Specialist | 1945 W Wilson Ave, Suite 6108, Chicago, IL 60640-5255 | 2017-03-30 |
| 1578001285 | Lakeshore Psychotherapy Group LLC | Psychologist | 1945 W Wilson Ave, Suite 6117, Chicago, IL 60640-5255 | 2017-02-02 |
| 1194192088 | Eva Lopez | Audiologist | 1945 W Wilson Ave, Suite 6108, Chicago, IL 60640-5255 | 2015-08-26 |
| 1861887036 | Robert L Neems Dds PC | Dentist | 1945 W Wilson Ave, Suite 5117, Chicago, IL 60640-5255 | 2015-04-03 |
| 1518365857 | Lauren Johnson | Social Worker | 1945 W Wilson Ave, Suite 5115, Chicago, IL 60640 | 2014-12-19 |
| 1902239460 | Melissa Kwafo | Social Worker | 1945 W Wilson Ave, Chicago, IL 60640-5255 | 2013-08-19 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336754233 | Rci (wrs), LLC. | Clinic/Center | 5221-23 North Broadway, Chicago, IL 60640 | 2020-09-09 |
| 1548871916 | Borici Counseling LLC | Counselor | 4731 N Paulina St, Chicago, IL 60640 | 2020-08-11 |
| 1306319173 | Gerardo Garcia | Physician Assistant | Medical Staff Office, Weiss Memorial Hospital, 4646 N Marine Drive, Chicago, IL 60640 | 2019-01-04 |
| 1386121283 | Aea Optical Ventures, LLC | Clinic/Center | 4814 N Clark St, Chicago, IL 60640 | 2018-07-24 |
| 1023503885 | Lauren Vassiliades | Internal Medicine | Weiss Memorial Hospital, Medical Education Dpt., 4646 N. Marine Drive, C Elevators, 7th Flr. # 7100, Chicago, IL 60640 | 2018-06-25 |
| 1477061620 | Yesenia Vargas | Nurse Practitioner | 1025 W Sunnyside, Chicago, IL 60640 | 2018-01-22 |
| 1932622206 | Jasleen Kaur Brar | Internal Medicine | 4646 N. Marine Dr., Chicago, IL 60640 | 2017-07-19 |
| 1750802849 | Umer Mukhtar | Internal Medicine | 4646 N. Marine Dr. Med Ed Dept. C Elevators., Weiss Memorial Hospital. 7 Floor. #7100, Chicago, IL 60640 | 2017-06-29 |
| 1184144081 | Ellie Navidson | Registered Nurse | 1015 W Lawrence, 2nd Floor, Chicago, IL 60640 | 2017-06-21 |
| 1962932558 | Jennifer Stridh | Marriage & Family Therapist | 5125 N. Winthrop Ave, 1f, Chicago, IL 60640 | 2017-06-15 |
| Find all providers in zip 60640 | ||||
| Taxonomy Code | 207RA0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Adolescent Medicine |
| An internist who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194248914 | Mohamed Ihtesham Shaji | Internal Medicine | 4646 N Marine Dr, Chicago, IL 60640-5759 | 2017-07-24 |
| 1679969182 | Greg D Ewert Md Sc | Internal Medicine | 200 S Michigan Ave, Suite 805, Chicago, IL 60604-2402 | 2015-04-10 |
| 1487993911 | Eilis Ryan | Internal Medicine | 6500 W 65th St, Chicago, IL 60638-4962 | 2013-02-04 |
| 1831496322 | Capital Health Inc | Internal Medicine | 7107 W Belmont Ave, Suite 8, Chicago, IL 60634-4688 | 2011-02-17 |
| 1447297890 | Surabhi Mehrotra | Internal Medicine | 1645 W Jackson Blvd, Suite 215, Chicago, IL 60612-3276 | 2006-06-01 |
| 1255304382 | Win Care Medical Consultants Ltd | Internal Medicine | 4646 N Marine Dr Ste A6100, Chicago, IL 60640-5759 | 2006-02-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447446257 | Farah Tazeen | Internal Medicine | 1 S 161 Summit Ave., Oak Brook Terrace, IL 60181-3904 | 2007-09-15 |
| 1114142643 | Christina B Nulty | Internal Medicine | 912 N Elmwood Ave, Peoria, IL 61625-0001 | 2007-04-17 |
| 1679665020 | Lynessa A Alonso | Internal Medicine | 10 Saint Clare Ct, Washington, IL 61571-9239 | 2006-09-29 |
| 1447273859 | Samir Shah M.d.s.c | Internal Medicine | 3560 W 95th St, Evergreen Park, IL 60805-2107 | 2006-07-26 |
| 1437599867 | Shakuntala Sachin Patil | Internal Medicine | 611 W Park St, Carle Forum Ll, Urbana, IL 61801-2500 | 2013-06-29 |
| 1356507834 | Woodridgeclinic S.c | Internal Medicine | 805 S Main St, Lombard, IL 60148-3300 | 2008-08-04 |
| 1043338189 | Sarah Bush Lincoln Health Center | Internal Medicine | 200 Richmond Ave E, Mattoon, IL 61938-4652 | 2007-03-27 |
| 1922140300 | Elizabeth Carazo | Internal Medicine | 500 W Central Rd, Suite 106, Mt Prospect, IL 60056-2347 | 2007-02-13 |
| 1366544249 | Joanne Frances Connolly | Internal Medicine | 633 Emerson St, Evanston, IL 60208-4000 | 2006-09-02 |
| 1427072768 | Samir K Shah | Internal Medicine | 2350 N Rockton Ave, Rockford, IL 61103-3600 | 2006-07-27 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.