Provider Demographics
NPI:1477646222
Name:ZACHARY, LAWRENCE S (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:S
Last Name:ZACHARY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4646 N MARINE DR
Mailing Address - Street 2:5B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5759
Mailing Address - Country:US
Mailing Address - Phone:773-564-6120
Mailing Address - Fax:773-564-6121
Practice Address - Street 1:4646 N MARINE DR
Practice Address - Street 2:5B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5759
Practice Address - Country:US
Practice Address - Phone:773-564-6120
Practice Address - Fax:773-564-6121
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2023-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036060230208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC39263Medicare UPIN