Provider Demographics
NPI:1023021821
Name:LEVENTHAL, LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:LEVENTHAL
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 1:801 W TEMPLE AVE
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2168
Mailing Address - Country:US
Mailing Address - Phone:217-342-5800
Mailing Address - Fax:217-347-3311
Practice Address - Street 1:801 W TEMPLE AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2168
Practice Address - Country:US
Practice Address - Phone:217-342-5800
Practice Address - Fax:217-347-3311
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4813120001Medicare NSC
IL202883Medicare PIN
A27954Medicare UPIN
ILK36750Medicare PIN