Healthcare Provider Details

I. General information

NPI: 1124158936
Provider Name (Legal Business Name): TERRENCE T. LERNER, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N HALSTED ST SUITE 625
CHICAGO IL
60657-5188
US

IV. Provider business mailing address

777 OAKMONT LN SUITE 1600
WESTMONT IL
60559-5511
US

V. Phone/Fax

Practice location:
  • Phone: 773-767-7414
  • Fax: 773-296-5009
Mailing address:
  • Phone: 630-789-2550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: TERRENCE T. LERNER
Title or Position: PRESIDENT OWNER
Credential: M.D.
Phone: 773-767-7414