Provider Demographics
NPI:1427025998
Name:FAULKNER, LARRY RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:RAY
Last Name:FAULKNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2150 E LAKE COOK RD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1862
Mailing Address - Country:US
Mailing Address - Phone:847-229-6500
Mailing Address - Fax:847-229-6600
Practice Address - Street 1:2150 E LAKE COOK RD
Practice Address - Street 2:SUITE 900
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1862
Practice Address - Country:US
Practice Address - Phone:847-229-6500
Practice Address - Fax:847-229-6600
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.1159472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCC92604Medicare UPIN