Healthcare Provider Details

I. General information

NPI: 1922012541
Provider Name (Legal Business Name): MARTIN LANOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 S MILWAUKEE AVE
LIBERTYVILLE IL
60048-3279
US

IV. Provider business mailing address

712 S MILWAUKEE AVE
LIBERTYVILLE IL
60048-3279
US

V. Phone/Fax

Practice location:
  • Phone: 847-821-7070
  • Fax: 847-232-2415
Mailing address:
  • Phone: 847-821-7070
  • Fax: 847-232-2415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number036-073349
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: