Provider Demographics
NPI:1730188228
Name:LAWRENCE LINDEMAN MD SC
Entity type:Organization
Organization Name:LAWRENCE LINDEMAN MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LINDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-832-1081
Mailing Address - Street 1:PO BOX 872
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60204-0872
Mailing Address - Country:US
Mailing Address - Phone:773-832-1081
Mailing Address - Fax:773-832-1082
Practice Address - Street 1:2255 W ROSCOE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6238
Practice Address - Country:US
Practice Address - Phone:773-832-1081
Practice Address - Fax:773-832-1082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN210503Medicare ID - Type UnspecifiedGROUP NUMBER