Provider Demographics
NPI:1346899705
Name:APPLEWHITE, LAMONT
Entity Type:Individual
Prefix:
First Name:LAMONT
Middle Name:
Last Name:APPLEWHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14225 KIMBARK AVE
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-1307
Mailing Address - Country:US
Mailing Address - Phone:312-890-6231
Mailing Address - Fax:
Practice Address - Street 1:14225 KIMBARK AVE
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-1307
Practice Address - Country:US
Practice Address - Phone:312-890-6231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies