Provider Demographics
NPI:1578733317
Name:JAMES LAVELL D.P.M., LTD.
Entity Type:Organization
Organization Name:JAMES LAVELL D.P.M., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-525-0204
Mailing Address - Street 1:2032 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3910
Mailing Address - Country:US
Mailing Address - Phone:773-525-0204
Mailing Address - Fax:773-525-5098
Practice Address - Street 1:2032 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3910
Practice Address - Country:US
Practice Address - Phone:773-525-0204
Practice Address - Fax:773-525-5098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003259213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4493810001Medicare NSC