Healthcare Provider Details

I. General information

NPI: 1174560338
Provider Name (Legal Business Name): LAWRENCE ALLEN BARR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 E BRUSH HILL RD STE 202
ELMHURST IL
60126-5661
US

IV. Provider business mailing address

133 E BRUSH HILL RD STE 202
ELMHURST IL
60126-5661
US

V. Phone/Fax

Practice location:
  • Phone: 331-231-6200
  • Fax: 331-231-6201
Mailing address:
  • Phone: 331-231-6200
  • Fax: 331-231-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036.064451
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number036064451
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: