Healthcare Provider Details

I. General information

NPI: 1831147164
Provider Name (Legal Business Name): LAWRENCE M KAUFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
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 Number036-074319
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number036074319
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: