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General NPI Number Information
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NPI Number | 1508881491
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Entity Type | Individual
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Provider Name | LAWRENCE SPLITTER D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 3024 E EMPIRE ST STE 3A
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City | BLOOMINGTON
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State | IL
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Zip | 61704-5402
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Country | US
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Telephone | 309-556-7775
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Fax |
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Provider Business Mailing Address
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Address Line | 611 W PARK ST FAPC
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City | URBANA
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State | IL
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Zip | 61801
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Country | US
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Telephone | 406-237-4114
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number | 4185
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 036106936
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License Number State | IL
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