Healthcare Provider Details

I. General information

NPI: 1730188228
Provider Name (Legal Business Name): LAWRENCE LINDEMAN MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 W ROSCOE ST
CHICAGO IL
60618-6238
US

IV. Provider business mailing address

PO BOX 872
EVANSTON IL
60204-0872
US

V. Phone/Fax

Practice location:
  • Phone: 773-832-1081
  • Fax: 773-832-1082
Mailing address:
  • Phone: 773-832-1081
  • Fax: 773-832-1082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: LAWRENCE A LINDEMAN
Title or Position: OWNER
Credential: M.D.
Phone: 773-832-1081