MEDICARE: LAWRENCE SPLITTER D.O.

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	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	4185	MT
2	2083X0100X	Occupational Medicine Physician	036106936	IL

General Provider Information

NPI Number	:	1508881491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE SPLITTER D.O.

Provider Business Mailing Address
First Line	:	611 W PARK ST
Second Line	:	FAPC
City	:	URBANA
State	:	IL
Zip	:	61801
Country	:	US
Telephone Number	:	406-237-4114
Fax Number	:

Provider Business Practice Location Address
First Line	:	3024 E EMPIRE ST STE 3A
Second Line	:
City	:	BLOOMINGTON
State	:	IL
Zip	:	61704-5402
Country	:	US
Telephone Number	:	309-556-7775
Fax Number	:

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	08/12/2020

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