NPI 1003011628

Lake Shore Pediatrics, LTD

Organisation Pediatrics Physician Lake Forest, IL

Practice location

Address: 900 N Westmoreland Rd Suite 106, Lake Forest, IL 60045-1674
Phone: (847) 615-4654
Fax: (847) 615-1708

Authorised official

Name: Diane Wheeler Fondriest
Title: Managing Partner
Phone: (847) 615-4654

Registered specialties

Pediatrics Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208000000X Licence 36065837 (IL)

Other Pediatrics providers in Illinois →

Registry record

NPI: 1003011628
Entity type: Organization
NPI issued: 15 Jun 2007
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.