LAKESHORE P.E.T IMAGING, LLC. (NPI# 1790870699) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790870699 |
| Entity Type | Organization |
| Organization Name | LAKESHORE P.E.T IMAGING, LLC. |
| Practice Address |
4932 W 95th St Oak Lawn IL 60453-2504 |
| Practice Telephone | 7084999700 |
| Practice Fax Number | 7084999797 |
| Mailing Telephone | 7084999700 |
| Mailing Fax Number | 7084999797 |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | NEELAM S AUNG (OFFICE MANAGER) |
| Authorized Official Telephone | 7084999700 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BCBS | 01633190 | 01 |
| Street Address |
4932 W 95TH ST |
| City | OAK LAWN |
| State | IL |
| Zip Code | 60453-2504 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124672654 | Samuel George Tambeaux | Dietitian, Registered | 4932 W 95th St, Oak Lawn, IL 60453 | 2019-08-01 |
| 1457738155 | Molecular Imaging Chicago LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 4932 W 95th St, Oak Lawn, IL 60453-2504 | 2015-05-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659995231 | Natalia Zero | Student in an Organized Health Care Education/Training Program | 4440 W 95th St, Rm 131 North, Oak Lawn, IL 60453 | 2020-05-30 |
| 1114554300 | Sylvia Maria Chlebek | Student in an Organized Health Care Education/Training Program | Advocate Christ Medical Center 4440 W. 95th St., Rm 131 North, Oak Lawn, IL 60453 | 2020-03-26 |
| 1972066751 | Amanda Mroczek | Family Medicine | 9555 52nd Avenue, Suite F, Oak Lawn, IL 60453 | 2019-04-09 |
| 1013479955 | Leah Rae Prager | Physician Assistant | 4400 W. 95th St., Attn: Pediatric General Surgery, Oak Lawn, IL 60453 | 2019-04-01 |
| 1659833473 | Chelsea Sumida Gipson | Family Medicine | 9555 South 52nd Avenue, Suite F, Oak Lawn, IL 60453 | 2019-04-01 |
| 1518427418 | Robert Lindgren | Family Medicine | 9555 S. 52nd Ave., Suite F, Oak Lawn, IL 60453 | 2019-03-25 |
| 1154886695 | Stephanie Anne Comer | Social Worker | 10102 South Cicero Avenue, Suite C, Oak Lawn, IL 60453 | 2019-02-08 |
| 1700360070 | Brian L Lee | Counselor | 8938 S Ridgeland Avenue Suite 100, Oak Lawn, IL 60453 | 2018-09-21 |
| 1679085245 | International Dental of Oak Lawn | Clinic/Center | 9539 S Cicero Ave, Oak Lawn, IL 60453 | 2017-11-03 |
| 1124538301 | Kavitha Rajendran | Physician Assistant | 5851 W. 95th Street, Suite 300, Oak Lawn, IL 60453 | 2017-10-02 |
| Find all providers in zip 60453 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497213110 | Solley's Medical Group | Clinic/Center | 4239 W 95th St, Oak Lawn, IL 60453-2623 | 2019-03-12 |
| 1982148383 | Nora T. Bellosa, M.d.,s.c. | Clinic/Center | 10448 S Pulaski Rd, Oak Lawn, IL 60453-4895 | 2016-12-05 |
| 1952532269 | Advanced Clinics PC | Clinic/Center | 10644 S Cicero Ave, Oak Lawn, IL 60453-5268 | 2009-08-04 |
| 1912936014 | Advocate Health & Hospitals Corporation | Clinic/Center | 4440 W 95th St, Oak Lawn, IL 60453-2600 | 2006-07-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295351062 | Sara M Gotheridge Md LLC | Clinic/Center | 630 Davis St Ste 301, Evanston, IL 60201-4480 | 2020-06-17 |
| 1407484645 | Macumber Medical Ltd | Clinic/Center | 3114 W Irving Park Rd Ste 1w, Chicago, IL 60618-3435 | 2020-04-01 |
| 1477181782 | Embassy Studios North | Clinic/Center | 6455 N Cicero Ave, Lincolnwood, IL 60712-3407 | 2020-03-31 |
| 1689226318 | Midway Spine and Joint Pain Physicians | Clinic/Center | 5720 S Pulaski Rd, Chicago, IL 60629-4435 | 2019-07-12 |
| 1215598891 | Vero Clinics | Clinic/Center | 1192 E Pershing Rd, Decatur, IL 62526-4753 | 2019-06-25 |
| 1497215933 | Activate Healthcare | Clinic/Center | 2010 N Damen Ave Unit F, Chicago, IL 60647-3286 | 2019-03-21 |
| 1033699467 | Healthpointe Medical Center Sc | Clinic/Center | 530 Fullerton Rd Ste B, Swansea, IL 62226-2970 | 2018-08-15 |
| 1740794882 | Highland Park Cvs, L.L.C. | Clinic/Center | 72 Airport Plz, Bethalto, IL 62010-1774 | 2017-11-28 |
| 1447764014 | Dr Courtney Drendel Inc | Clinic/Center | 515 Hamilton St # 100, Geneva, IL 60134-2138 | 2017-11-19 |
| 1699206599 | David M Conner M.d. | Clinic/Center | 9 Executive Woods Ct Ste 2, Swansea, IL 62226-2016 | 2017-03-22 |
| Find all providers with the same taxonomy | ||||
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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.