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Lake Shore Ob Gyn Of Decatur S C
Specialist in Decatur, Illinois
NPI 1700925583

Lake Shore Ob Gyn Of Decatur S C is a Specialist based in Decatur, IL. Lake Shore Ob Gyn Of Decatur S C practices in Decatur, IL. The NPI Number for Lake Shore Ob Gyn Of Decatur S C is 1700925583 and holds a License No. (Illinois).

The current practice location address for Lake Shore Ob Gyn Of Decatur S C is 1770 E Lake Shore Dr, Decatur, IL and can be reached out via phone at 217-429-4119 and via fax at 217-429-0108.

Location: 1770 E Lake Shore Dr, Decatur, IL, 62521-3832
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1700925583
Provider Name
Lake Shore Ob Gyn Of Decatur S C
Credential
Provider Entity Type
Organization
Address
1770 E Lake Shore Dr, Decatur, IL, 62521-3832
Phone Number
217-429-4119
Fax Number
217-429-0108
Provider Enumeration Date
02/06/2007
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
634112 01 HEALTH LINK
036110172 05 IL
05832038 01 IL BLUE CROSS BLUE SHIELD
institution
Provider Business Practice Location Address Details
Address
1770 E Lake Shore Dr
City
Decatur
State
Illinois
Zip
62521-3832
Phone Number
217-429-4119
Fax Number
217-429-0108
person
Provider Business Mailing Address Details
Address
1770 E Lake Shore Dr
City
Decatur
State
Illinois
Zip
62521-3832
Phone Number
217-429-4119
Fax Number
217-429-0108
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
()
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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