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NPI Code Detail

MEDICARE: LAWRENCE DONALDSON JR.

MEDICARE: LAWRENCE DONALDSON JR.
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
1172A00000XDriverD54352086052IL

General Provider Information

NPI Number : 1790549202
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAWRENCE DONALDSON JR.
Provider Business Mailing Address
First Line : 2735 HASSERT BLVD STE 135
Second Line :
City : NAPERVILLE
State : IL
Zip : 60564-5205
Country : US
Telephone Number : 331-216-1740
Fax Number :
Provider Business Practice Location Address
First Line : 2735 HASSERT BLVD STE 135
Second Line :
City : NAPERVILLE
State : IL
Zip : 60564-5205
Country : US
Telephone Number : 331-216-1740
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2024
Last Update Date : 02/06/2024

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Directions to “ LAWRENCE DONALDSON JR. ” Practice Location

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