Healthcare Provider Details

I. General information

NPI: 1013174440
Provider Name (Legal Business Name): MELANIE C. LACHMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6428 JOLIET RD
LA GRANGE HIGHLANDS IL
60525-4646
US

IV. Provider business mailing address

6410 JOLIET RD
COUNTRYSIDE IL
60525-4642
US

V. Phone/Fax

Practice location:
  • Phone: 708-352-4448
  • Fax: 708-352-1052
Mailing address:
  • Phone: 708-352-4448
  • Fax: 708-352-1052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-120961
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: