MEDICARE: LAWRENCE M KAUFMAN M.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
1	207W00000X	Ophthalmology Physician	036-074319	IL
2	207WX0110X	Pediatric Ophthalmology and Strabismus Specialist Physician Physician	036074319	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	31603018	OTHER		BLUE CROSS ID

General Provider Information

NPI Number	:	1831147164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE M KAUFMAN M.D.

Provider Business Mailing Address
First Line	:	2456 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2012
Country	:	US
Telephone Number	:	773-235-2020
Fax Number	:	773-235-2037

Provider Business Practice Location Address
First Line	:	2456 N WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2012
Country	:	US
Telephone Number	:	773-235-2020
Fax Number	:	773-235-2037

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	10/12/2018

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