Provider Demographics
NPI:1053315721
Name:STEIN, LAWRENCE NEAL (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:NEAL
Last Name:STEIN
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 1:4956 WILDERNESS PT
Mailing Address - Street 2:
Mailing Address - City:SMITHTON
Mailing Address - State:IL
Mailing Address - Zip Code:62285-3664
Mailing Address - Country:US
Mailing Address - Phone:618-473-3618
Mailing Address - Fax:
Practice Address - Street 1:4956 WILDERNESS PT
Practice Address - Street 2:
Practice Address - City:SMITHTON
Practice Address - State:IL
Practice Address - Zip Code:62285-3664
Practice Address - Country:US
Practice Address - Phone:618-473-3618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087808207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087808Medicaid
ILA78825Medicare UPIN