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General NPI Number Information
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NPI Number | 1720134422
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Entity Type | Individual
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Provider Name | TIMOTHY T LANTVIT DPM
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Gender | Male
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 01/22/2019
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Provider Practice Location Address
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Address Line | 40 SKOKIE BLVD STE 520
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City | NORTHBROOK
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State | IL
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Zip | 60062-1601
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Country | US
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Telephone | 847-504-5000
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Fax | 847-504-5015
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Provider Business Mailing Address
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Address Line | PO BOX 917
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City | NORTHBROOK
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State | IL
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Zip | 60065-0917
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Country | US
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Telephone | 847-504-5000
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Fax | 847-504-5015
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 07000775
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016004656
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License Number State | IL
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