Provider Demographics
NPI:1760469639
Name:LOMASNEY, LAURIE (MD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:LOMASNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S FIRST AVE
Mailing Address - Street 2:MCGAW ENT., RM. 47
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-5221
Mailing Address - Fax:708-216-0899
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:MCGAW ENT., RM. 47
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-5221
Practice Address - Fax:708-216-0899
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL360859732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36085973Medicaid
IL367160Medicare ID - Type Unspecified
ILL80860Medicare ID - Type Unspecified
IL36085973Medicaid