<Unavail>

LBN: Katrina Lake Md Llc
<Unavail> is an health care organization with primary practice located at 18503 Bellamy Rd , Country Club Hills IL 60478-5279. The organization recently has only one registered license in Ambulatory Health Care Facilities / Multi-Specialty, which is considered as the primary health care specialty. Katrina Lake Md Llc can be contacted via phone (708) 365-8343, or through Lake, Katrina via phone (708) 308-8974.

Contact Information

Primary practice address
18503 Bellamy Rd Country Club Hills IL 60478-5279
Phone: (708) 365-8343
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Lake, Katrina Doctor of Medicine (MD)
Phone: (708) 308-8974

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Multi-Specialty 261QM1300X

Profile Details

NPI number 1013536663
LBN Legal business name Katrina Lake Md Llc
DBA Doing business as <Unavail>
Authorized official Lake, Katrina Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Apr 14th, 2020
Last updated May 1st, 2020 - about 6 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013536663 NPPES
Illinois MEDICAID 036141229

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