Healthcare Provider Details

I. General information

NPI: 1245527183
Provider Name (Legal Business Name): JOSHUA M LENNON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9138 RIDGEWAY AVE
SKOKIE IL
60076-1754
US

IV. Provider business mailing address

9138 RIDGEWAY AVE
SKOKIE IL
60076-1754
US

V. Phone/Fax

Practice location:
  • Phone: 847-677-3626
  • Fax:
Mailing address:
  • Phone: 847-677-3626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036135161
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036135161
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: