MEDICARE: DR. LARRY RAY FAULKNER M.D.

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	2084P0800X	Psychiatry Physician	036.115947	IL

General Provider Information

NPI Number	:	1427025998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY RAY FAULKNER M.D.

Provider Business Mailing Address
First Line	:	2150 E LAKE COOK RD
Second Line	:	SUITE 900
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-1862
Country	:	US
Telephone Number	:	847-229-6500
Fax Number	:	847-229-6600

Provider Business Practice Location Address
First Line	:	2150 E LAKE COOK RD
Second Line	:	SUITE 900
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-1862
Country	:	US
Telephone Number	:	847-229-6500
Fax Number	:	847-229-6600

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

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	01/11/2012

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