Provider Demographics
NPI:1356518559
Name:LIFESPAN MEDICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:LIFESPAN MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:DR
Authorized Official - First Name:BINO
Authorized Official - Middle Name:
Authorized Official - Last Name:OOMMEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-301-3921
Mailing Address - Street 1:724 E KENSINGTON RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-6201
Mailing Address - Country:US
Mailing Address - Phone:847-222-9595
Mailing Address - Fax:847-222-9565
Practice Address - Street 1:724 E KENSINGTON RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-6201
Practice Address - Country:US
Practice Address - Phone:847-222-9595
Practice Address - Fax:847-222-9565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036119123Medicaid