MEDICARE: LAUREN SAXE MD

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	207W00000X	Ophthalmology Physician	036079170	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L64595	OTHER	IL	PTAN

General Provider Information

NPI Number	:	1700822590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN SAXE MD

Provider Business Mailing Address
First Line	:	18440 GOVERNORS HWY
Second Line	:
City	:	HOMEWOOD
State	:	IL
Zip	:	60430-2911
Country	:	US
Telephone Number	:	708-798-2191
Fax Number	:	708-798-2317

Provider Business Practice Location Address
First Line	:	18440 GOVERNORS HWY
Second Line	:
City	:	HOMEWOOD
State	:	IL
Zip	:	60430-2911
Country	:	US
Telephone Number	:	708-798-2191
Fax Number	:	708-798-2317

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	07/12/2010

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