MEDICARE: MAX LEDERSNAIDER 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	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	125081437	IL

General Provider Information

NPI Number	:	1831846542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAX LEDERSNAIDER MD

Provider Business Mailing Address
First Line	:	420 E SUPERIOR ST STE 9-900
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-4494
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	467 W DEMING PL STE 6000
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1881
Country	:	US
Telephone Number	:	312-227-6450
Fax Number	:	312-227-9441

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

Provider Enumeration Date	:	03/03/2022
Last Update Date	:	06/06/2024

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Directions to “ MAX LEDERSNAIDER MD” Practice Location

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