Healthcare Provider Details

I. General information

NPI: 1881608354
Provider Name (Legal Business Name): LAWRENCE LERNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 E MAIN ST
EAST DUNDEE IL
60118-1529
US

IV. Provider business mailing address

455 E MAIN ST
EAST DUNDEE IL
60118-1529
US

V. Phone/Fax

Practice location:
  • Phone: 847-428-2273
  • Fax: 847-428-3128
Mailing address:
  • Phone: 847-428-2273
  • Fax: 847-428-3128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number036048969
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: