Healthcare Provider Details

I. General information

NPI: 1740222363
Provider Name (Legal Business Name): BRADLEY R. LAWTON, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 DRESDEN DR
MORRIS IL
60450-2476
US

IV. Provider business mailing address

1300 DRESDEN DR
MORRIS IL
60450-2476
US

V. Phone/Fax

Practice location:
  • Phone: 815-942-5200
  • Fax: 815-942-5330
Mailing address:
  • Phone: 815-942-5200
  • Fax: 815-942-5330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: MARY M. SMITH
Title or Position: BILLER/CODER
Credential:
Phone: 815-942-5200