Healthcare Provider Details

I. General information

NPI: 1053315721
Provider Name (Legal Business Name): LAWRENCE NEAL STEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4956 WILDERNESS PT
SMITHTON IL
62285-3664
US

IV. Provider business mailing address

4956 WILDERNESS PT
SMITHTON IL
62285-3664
US

V. Phone/Fax

Practice location:
  • Phone: 618-473-3618
  • Fax:
Mailing address:
  • Phone: 618-473-3618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number036087808
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: