Healthcare Provider Details

I. General information

NPI: 1629074422
Provider Name (Legal Business Name): JAMES LAVELL D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JAMES LAVELL D.P.M.

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2032 W IRVING PARK RD
CHICAGO IL
60618-3910
US

IV. Provider business mailing address

2032 W IRVING PARK RD
CHICAGO IL
60618-3910
US

V. Phone/Fax

Practice location:
  • Phone: 773-525-0204
  • Fax: 773-525-5098
Mailing address:
  • Phone: 773-525-0204
  • Fax: 773-525-5098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016003259
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: