Healthcare Provider Details

I. General information

NPI: 1063733400
Provider Name (Legal Business Name): LAWRENCE M KAUFMAN, M.D., PH.D., SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 10/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2456 N WESTERN AVE
CHICAGO IL
60647-2012
US

IV. Provider business mailing address

2456 N WESTERN AVE
CHICAGO IL
60647-2012
US

V. Phone/Fax

Practice location:
  • Phone: 773-235-2020
  • Fax: 773-235-2037
Mailing address:
  • Phone: 773-235-2020
  • Fax: 773-235-2037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LAWRENCE MATHEW KAUFMAN
Title or Position: OWNER
Credential: M.D.,PH.D.
Phone: 773-235-2020