Provider Demographics
NPI:1598989667
Name:IM, LORNA L (MD)
Entity Type:Individual
Prefix:
First Name:LORNA
Middle Name:L
Last Name:IM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:800 W CENTRAL RD
Mailing Address - Street 2:DEPT OF ANESTHESIA
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2349
Mailing Address - Country:US
Mailing Address - Phone:847-618-1000
Mailing Address - Fax:847-255-8084
Practice Address - Street 1:800 W CENTRAL RD
Practice Address - Street 2:DEPT OF ANESTHESIA
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2349
Practice Address - Country:US
Practice Address - Phone:847-618-1000
Practice Address - Fax:847-255-8084
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093334207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036093334Medicaid
IL036093334Medicaid
IL593630Medicare PIN