Provider Demographics
NPI:1003899741
Name:LEMONT MEDICAL SC
Entity Type:Organization
Organization Name:LEMONT MEDICAL SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:FREDERIC
Authorized Official - Last Name:EDELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-243-6300
Mailing Address - Street 1:15900 127TH STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439
Mailing Address - Country:US
Mailing Address - Phone:630-243-6300
Mailing Address - Fax:630-243-6336
Practice Address - Street 1:15900 127TH STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439
Practice Address - Country:US
Practice Address - Phone:630-243-6300
Practice Address - Fax:630-243-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G85642Medicare UPIN
IL574090Medicare ID - Type UnspecifiedWILL COUNTY
IL626060Medicare ID - Type UnspecifiedCOOK COUNTY