Healthcare Provider Details

I. General information

NPI: 1073705547
Provider Name (Legal Business Name): PATRICK MCCAFFERTY LANK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E ONTARIO ST SUITE 200
CHICAGO IL
60611-3468
US

IV. Provider business mailing address

211 E ONTARIO ST SUITE 200
CHICAGO IL
60611-3468
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-6494
  • Fax:
Mailing address:
  • Phone: 312-926-6494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number036-125279
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License Number036-125279
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberAN52403942316
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: