Healthcare Provider Details

I. General information

NPI: 1376651968
Provider Name (Legal Business Name): J. KEITH LEMMON, M.D., S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 W LAKE AVE SUITE 412
GLENVIEW IL
60026-5805
US

IV. Provider business mailing address

3633 W LAKE AVE SUITE 412
GLENVIEW IL
60026-5805
US

V. Phone/Fax

Practice location:
  • Phone: 847-657-6060
  • Fax: 847-657-7070
Mailing address:
  • Phone: 847-657-6060
  • Fax: 847-657-7070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: J KEITH LEMMON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-657-6060