OrganizationLake Street Family Physicians Sc IncFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address1010 W Lake St, Suite 500, Oak Park, IL 60301(708) 524-8600PECOS EnrollmentBased on the most recent information from CMS, provider Lake Street Family Physicians Sc Inc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1841363850Provider TypeOrganizationFull NameLake Street Family Physicians Sc IncSubpartNoEnumeration Date11/16/2006Last Updated2/12/2013Contact InformationPractice LocationPractice Address1010 W Lake St, Suite 500, Oak Park, IL 60301Phone(708) 524-8600Fax(708) 524-8147Mailing LocationMailing AddressPO Box 799, Oak Park, IL 60303Phone(708) 524-8600Fax(708) 524-8147Authorized OfficialNameBell, Nancy (Practice Manager)Phone(708) 524-8600Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense042618366IllinoisProvider IdentifiersIDDescriptionIssuerIDDD3406DescriptionOtherIssuerMEDICARE RAILROADIllinoisID01634822DescriptionOtherIssuerBCBSIllinois