Provider Demographics
NPI:1710273669
Name:LAMBERT, CARL EARL (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:EARL
Last Name:LAMBERT
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 1:5425 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-2342
Mailing Address - Country:US
Mailing Address - Phone:773-378-3347
Mailing Address - Fax:773-378-4028
Practice Address - Street 1:5425 W LAKE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-2342
Practice Address - Country:US
Practice Address - Phone:773-378-3347
Practice Address - Fax:773-378-4028
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125060224207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine