Provider Demographics
NPI:1245226422
Name:LERNER, TERRENCE (MD)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:
Last Name:LERNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3000 N HALSTED ST
Mailing Address - Street 2:SUITE 625
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5188
Mailing Address - Country:US
Mailing Address - Phone:773-767-7414
Mailing Address - Fax:773-296-3002
Practice Address - Street 1:3000 N HALSTED ST
Practice Address - Street 2:SUITE 405
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5188
Practice Address - Country:US
Practice Address - Phone:773-767-7414
Practice Address - Fax:773-296-3002
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2015-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-060873208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC46182Medicare UPIN