MEDICARE: LAWRENCE M KAUFMAN, M.D., PH.D., SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician
2	207WX0110X	Pediatric Ophthalmology and Strabismus Specialist Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	31603018	OTHER	IL	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063733400
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE M KAUFMAN, M.D., PH.D., SC

Provider Business Mailing Address
First Line	:	2456 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2012
Country	:	US
Telephone Number	:	773-235-2020
Fax Number	:	773-235-2037

Provider Business Practice Location Address
First Line	:	2456 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2012
Country	:	US
Telephone Number	:	773-235-2020
Fax Number	:	773-235-2037

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LAWRENCE MATHEW KAUFMAN
Credential	:	M.D.,PH.D.
Telephone Number	:	773-235-2020

Provider Enumeration Date	:	06/21/2010
Last Update Date	:	10/12/2018

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