Healthcare Provider Details

I. General information

NPI: 1942889167
Provider Name (Legal Business Name): LAUREN ELIZABETH RIVKIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 S MARYLAND AVE # 3707
CHICAGO IL
60637-1425
US

IV. Provider business mailing address

5721 S MARYLAND AVE
CHICAGO IL
60637-1425
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-6205
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.181789
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA194972
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: