Healthcare Provider Details

I. General information

NPI: 1023104247
Provider Name (Legal Business Name): MARK B LAMPERT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9977 WOODS DR 3RD FLOOR
SKOKIE IL
60077-1057
US

IV. Provider business mailing address

2650 RIDGE AVE EVANSTON HOSPITAL
EVANSTON IL
60201-1718
US

V. Phone/Fax

Practice location:
  • Phone: 847-663-8410
  • Fax: 847-663-8411
Mailing address:
  • Phone: 847-570-1644
  • Fax: 847-733-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036081061
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: