Provider Demographics
NPI:1134557465
Name:CUMMINGS, LINDSEY
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:CUMMINGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1643 NORTH ORCHARD ST.
Mailing Address - Street 2:G01
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5488
Mailing Address - Country:US
Mailing Address - Phone:312-582-0905
Mailing Address - Fax:312-475-1328
Practice Address - Street 1:1643 N ORCHARD ST
Practice Address - Street 2:G01
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5161
Practice Address - Country:US
Practice Address - Phone:312-582-0905
Practice Address - Fax:312-475-1328
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILC55252183266343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)