Provider Demographics
NPI:1003924127
Name:TAYLOR, LYNDON D (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNDON
Middle Name:D
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 N HARLEM AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1205
Mailing Address - Country:US
Mailing Address - Phone:708-628-3390
Mailing Address - Fax:708-628-3385
Practice Address - Street 1:1515 N HARLEM AVE STE 308
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1205
Practice Address - Country:US
Practice Address - Phone:708-848-9440
Practice Address - Fax:708-848-4415
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036060997207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036060997Medicaid
IL036060997Medicaid
D15980Medicare UPIN