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LAKE SHORE OB GYN OF DECATUR S C
NPI 1700925583
Specialist in Decatur, IL

Active since February 06, 2007
741 W PERSHING RD, DECATUR, IL 62526(217) 429-4119(217) 429-0108 Get Directions Write a Review

NPPES record last updated: May 13, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Lake Shore Ob Gyn Of Decatur S C NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAKE SHORE OB GYN OF DECATUR S C (NPI 1700925583) is a healthcare organization registered as a specialist in Decatur, Illinois and active in the NPI registry since February 2007. The organization lists Adel Samy Hanna, Owner, as its authorized official.

NPPES Registry Identity

NPI1700925583
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameLAKE SHORE OB GYN OF DECATUR S C
Location Address741 W PERSHING RDDecatur, IL 62526-1634
Mailing Address1770 E Lake Shore Dr, Suite 303Decatur, IL 62521-3832 · (217) 429-4119 · Fax (217) 429-0108
Phone(217) 429-4119
Fax(217) 429-0108
Organization SubpartNo
Authorized OfficialAdel Samy HannaOwner · (217) 429-4119
Enumeration DateFebruary 6, 2007
Last NPPES UpdateMay 13, 2025
NPPES CertifiedMay 13, 2025
✔ NPI 1700925583 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
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.
741 W PERSHING RD, Decatur, IL 62526
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Other Identifiers 3

Other634112Health Link
Other05832038IL · Blue Cross Blue Shield
Medicaid036110172IL

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GOWDAR & GOWDAR MD SC
Family Medicine
741 W PERSHING RD
DECATUR, IL 62526
Macon County (217) 876-7200
DR. PRASANNA GOWDAR MD
Family Medicine
741 W PERSHING RD
DECATUR, IL 62526
Macon County (217) 876-7200
DR. KUSUMA GOWDAR MD
Pediatrics
741 W PERSHING RD
DECATUR, IL 62526
Macon County (217) 876-7200
NADA LYGRISSE D.O
Obstetrics & Gynecology
741 W PERSHING RD
DECATUR, IL 62526
Macon County (217) 429-4119

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lake Shore Ob Gyn Of Decatur S C's NPI number?

The NPI number for Lake Shore Ob Gyn Of Decatur S C is 1700925583. It was assigned to this organization in the NPPES registry on February 6, 2007.

Where is Lake Shore Ob Gyn Of Decatur S C located?

Lake Shore Ob Gyn Of Decatur S C is located at 741 W Pershing Rd, Decatur, IL 62526. The listed phone number is (217) 429-4119.

What is Lake Shore Ob Gyn Of Decatur S C's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

When was this NPI record last updated?

The NPPES record for Lake Shore Ob Gyn Of Decatur S C was last updated on May 13, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.