MEDICARE: JAMES LAVELL D.P.M., LTD.

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	213ES0103X	Foot & Ankle Surgery Podiatrist	016003259	IL

General Provider Information

NPI Number	:	1578733317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES LAVELL D.P.M., LTD.

Provider Business Mailing Address
First Line	:	2032 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3910
Country	:	US
Telephone Number	:	773-525-0204
Fax Number	:	773-525-5098

Provider Business Practice Location Address
First Line	:	2032 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3910
Country	:	US
Telephone Number	:	773-525-0204
Fax Number	:	773-525-5098

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES LAVELL
Credential	:	D.P.M.
Telephone Number	:	773-525-0204

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	03/10/2008

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