Healthcare Provider Details

I. General information

NPI: 1417967829
Provider Name (Legal Business Name): LAWRENCE U HASPEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 W 203RD ST STE 202
OLYMPIA FIELDS IL
60461-1184
US

IV. Provider business mailing address

3615 PARK DR SUITE 203
OLYMPIA FIELDS IL
60461-1186
US

V. Phone/Fax

Practice location:
  • Phone: 708-747-0461
  • Fax: 708-747-4704
Mailing address:
  • Phone: 708-748-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: