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NPI Code Detail

MEDICARE: DR. JEFFREY C LANFEAR PSY.D.

MEDICARE: DR. JEFFREY C LANFEAR PSY.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
1103TC0700XClinical Psychologist071-005830IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10001626556OTHERILBCBS PROVIDER #

General Provider Information

NPI Number : 1467523761
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY C LANFEAR PSY.D.
Provider Business Mailing Address
First Line : 5455 N SHERIDAN RD
Second Line : #3008
City : CHICAGO
State : IL
Zip : 60640-1958
Country : US
Telephone Number : 312-375-6796
Fax Number : 312-362-5561
Provider Business Practice Location Address
First Line : 500 N MICHIGAN AVE
Second Line : SUITE 1520
City : CHICAGO
State : IL
Zip : 60611-3777
Country : US
Telephone Number : 312-375-6796
Fax Number : 312-362-5561
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2006
Last Update Date : 07/08/2007

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