Provider Demographics
NPI:1114969904
Name:LEMUS, FRATERNO (M D)
Entity Type:Individual
Prefix:DR
First Name:FRATERNO
Middle Name:
Last Name:LEMUS
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14532 JOHN HUMPHREY DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2640
Mailing Address - Country:US
Mailing Address - Phone:708-460-5403
Mailing Address - Fax:708-460-0670
Practice Address - Street 1:14532 JOHN HUMPHREY DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2640
Practice Address - Country:US
Practice Address - Phone:708-460-5403
Practice Address - Fax:708-460-0670
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0549812084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL130023926OtherRAILROAD MEDICAREPALMETTO
IL036054981Medicaid
IL205923OtherUNITED HEALTH
IL216-07098-34OtherBLUECROSSBLUESHIELD
IL205923OtherUNITED HEALTH
363069564OtherEIN
IL216-07098-34OtherBLUECROSSBLUESHIELD