Provider Demographics
NPI:1386643864
Name:LINDEMAN, LAWRENCE A (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:A
Last Name:LINDEMAN
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:PO BOX 872
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60204-0872
Mailing Address - Country:US
Mailing Address - Phone:773-832-1081
Mailing Address - Fax:773-832-1082
Practice Address - Street 1:2255 W ROSCOE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6238
Practice Address - Country:US
Practice Address - Phone:773-832-1081
Practice Address - Fax:773-832-1082
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-069122207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036069122Medicaid
ILK12871Medicare PIN
ILD15497Medicare UPIN
IL210503Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER