Healthcare Provider Details

I. General information

NPI: 1275923021
Provider Name (Legal Business Name): NICHOLAS EDWARD LORENZ D.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2015
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 MOON LAKE BLVD STE 410
HOFFMAN ESTATES IL
60169-1073
US

IV. Provider business mailing address

185 AMHERST DR
BARTLETT IL
60103-4671
US

V. Phone/Fax

Practice location:
  • Phone: 312-801-4201
  • Fax:
Mailing address:
  • Phone: 312-801-4201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number181000390
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: