Healthcare Provider Details

I. General information

NPI: 1508881491
Provider Name (Legal Business Name): LAWRENCE SPLITTER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3024 E EMPIRE ST STE 3A
BLOOMINGTON IL
61704-5402
US

IV. Provider business mailing address

611 W PARK ST FAPC
URBANA IL
61801
US

V. Phone/Fax

Practice location:
  • Phone: 309-556-7775
  • Fax:
Mailing address:
  • Phone: 406-237-4114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number4185
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number036106936
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: