Lake Street Family Medicine, LLC
NPI 1639204613ActiveOrganization· Family Medicine· Addison, IL
Family Medicine in Addison, Illinois, registered in NPPES in February 2007. The authorized official on file is Brian Koecher, D.O., Physician. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1639204613 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Feb 22, 2007 |
| Last updated in NPPES | Dec 11, 2012 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Family Medicine Primary | 207Q00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (IL) |
|---|
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