Basic Information
| Provider Information | |||||||||
| NPI: | 1235475708 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTLAKE EMERGENCY ROOM PROVIDERS, SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | WESTLAKE EMERGENCY ROOM PROVIDERS, SC | ||||||||
| Address2: | DEPT 10303, PO BOX 87618 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606800618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304728800 | ||||||||
| FaxNumber: | 6304729502 | ||||||||
| Practice Location | |||||||||
| Address1: | WESTLAKE COMMUNITY HOSPITAL | ||||||||
| Address2: | 1225 W. LAKE STREET | ||||||||
| City: | MELROSE PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601604039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086813000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2013 | ||||||||
| LastUpdateDate: | 08/14/2019 | ||||||||
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| AuthorizedOfficialLastName: | WAKIM | ||||||||
| AuthorizedOfficialFirstName: | PIERRE | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6304728800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.