MEDICARE: IRA M LERNER, M.D.S.C.

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	208100000X	Physical Medicine & Rehabilitation Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31602068	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1154390805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRA M LERNER, M.D.S.C.

Provider Business Mailing Address
First Line	:	PO BOX 2086
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60065-2086
Country	:	US
Telephone Number	:	847-676-0091
Fax Number	:	847-676-2374

Provider Business Practice Location Address
First Line	:	2520 N LAKEVIEW AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2255
Country	:	US
Telephone Number	:	773-665-3470
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	IRA M LERNER
Credential	:	M.D.
Telephone Number	:	773-665-3470

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	08/22/2020

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