Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Lake Shore OB GYN of Decatur S C

Organization Specialist · NPI 1700925583

Lake Shore OB GYN of Decatur S C is a Specialist in Decatur, Illinois. Registered with an NPI since 2007.

In the registry since
2007

Practice location Address checks out

741 W Pershing Rd
Decatur, IL 62526-1634
Phone: (217) 429-4119
Fax: (217) 429-0108
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X

Record details

NPI number1700925583
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Adel Hanna — Owner · (217) 429-4119
NPI enumeratedFebruary 6, 2007
Last updated in NPPESMay 13, 2025
Certification dateMay 13, 2025
Mailing address1770 E Lake Shore Dr, Suite 303, Decatur, IL 62521-3832

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