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NPI Code Detail

MEDICARE: LAWRENCE T. KACMAR M.D., S.C.

MEDICARE: LAWRENCE T. KACMAR 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
1207QS0010XSports Medicine (Family Medicine) Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10005442619OTHERILAETNA
202232125OTHERILBLUE CROSS BLUE SHIELD ILLINOIS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
41767232OTHERILUNITED HEALTHCARE
51903680OTHERILCIGNA

General Provider Information

NPI Number : 1235225269
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAWRENCE T. KACMAR M.D., S.C.
Provider Business Mailing Address
First Line : 3965 75TH ST
Second Line : SUITE 103
City : AURORA
State : IL
Zip : 60504-7925
Country : US
Telephone Number : 630-375-1625
Fax Number : 630-375-1925
Provider Business Practice Location Address
First Line : 3965 75TH ST
Second Line : SUITE 103
City : AURORA
State : IL
Zip : 60504-7925
Country : US
Telephone Number : 630-375-1625
Fax Number : 630-375-1925
Authorized Official
Title or Position : OFFICE MANAGER
Name : MARGARET M COOLEY
Credential : LPN
Telephone Number : 630-375-1625
Provider Enumeration Date : 10/05/2006
Last Update Date : 07/23/2008

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1255567558 — LAWRENCE T. KACMAR MDSC
Practice Location Address:
3965 75TH ST , SUITE 103
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60504-7925
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Practice Fax: 630-375-1925

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