Provider Demographics
NPI:1306861067
Name:LENTING, ERIC L (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:L
Last Name:LENTING
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 1:311 S COUNTY FARM RD
Mailing Address - Street 2:STE B
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-2477
Mailing Address - Country:US
Mailing Address - Phone:630-690-6400
Mailing Address - Fax:630-690-6482
Practice Address - Street 1:311 S COUNTY FARM RD
Practice Address - Street 2:STE B
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-2477
Practice Address - Country:US
Practice Address - Phone:630-690-6400
Practice Address - Fax:630-690-6482
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-095053174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG52141Medicare UPIN
IL265820Medicare ID - Type Unspecified