Provider Demographics
NPI:1316984107
Name:LAKE FOREST PEDIATRIC ASSOCIATES, LTD
Entity type:Organization
Organization Name:LAKE FOREST PEDIATRIC ASSOCIATES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MACNAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-295-1220
Mailing Address - Street 1:900 N WESTMORELAND RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1674
Mailing Address - Country:US
Mailing Address - Phone:847-295-1220
Mailing Address - Fax:847-295-1255
Practice Address - Street 1:900 N WESTMORELAND RD
Practice Address - Street 2:SUITE 110
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1674
Practice Address - Country:US
Practice Address - Phone:847-295-1220
Practice Address - Fax:847-295-1255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center