MEDICARE: MADELINE LEMMENES APRN

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	209027672	IL

General Provider Information

NPI Number	:	1093562159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE LEMMENES APRN

Provider Business Mailing Address
First Line	:	7117 SEMINOLE DR
Second Line	:
City	:	DARIEN
State	:	IL
Zip	:	60561-4078
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	475 W 55TH ST STE 208AB
Second Line	:
City	:	COUNTRYSIDE
State	:	IL
Zip	:	60525-3564
Country	:	US
Telephone Number	:	708-579-0488
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2024
Last Update Date	:	05/06/2024

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