Provider Demographics
NPI:1750499356
Name:LEMMON, J KEITH (MD)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:KEITH
Last Name:LEMMON
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 1:3633 W LAKE AVE
Mailing Address - Street 2:SUITE 412
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-5805
Mailing Address - Country:US
Mailing Address - Phone:847-657-6060
Mailing Address - Fax:847-659-7070
Practice Address - Street 1:3633 W LAKE AVE
Practice Address - Street 2:SUITE 412
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-5805
Practice Address - Country:US
Practice Address - Phone:847-657-6060
Practice Address - Fax:847-657-7070
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036106306207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036106306Medicaid
IL0001636306OtherBLUE SHIELD BLUE CROSS