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General NPI Number Information
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NPI Number | 1699861682
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Entity Type | Individual
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Provider Name | LAWRENCE TIMOTHY KACMAR M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 02/26/2014
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Provider Practice Location Address
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Address Line | 3965 75TH ST SUITE 103
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City | AURORA
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State | IL
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Zip | 60504-7925
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Country | US
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Telephone | 630-375-1625
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Fax | 630-375-1925
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Provider Business Mailing Address
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Address Line | 3965 75TH ST SUITE 103
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City | AURORA
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State | IL
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Zip | 60504-7925
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Country | US
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Telephone | 630-375-1625
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Fax | 630-375-1925
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 036-091557
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License Number State | IL
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