Provider Demographics
NPI:1376651968
Name:J. KEITH LEMMON, M.D., S.C.
Entity Type:Organization
Organization Name:J. KEITH LEMMON, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:LEMMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-657-6060
Mailing Address - Street 1:3633 W LAKE AVE
Mailing Address - Street 2:SUITE 412
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-5805
Mailing Address - Country:US
Mailing Address - Phone:847-657-6060
Mailing Address - Fax:847-657-7070
Practice Address - Street 1:3633 W LAKE AVE
Practice Address - Street 2:SUITE 412
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-5805
Practice Address - Country:US
Practice Address - Phone:847-657-6060
Practice Address - Fax:847-657-7070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001636306OtherBLUE CROSS BLUE SHIELD
ILH74282Medicare UPIN