Provider Demographics
NPI:1760498612
Name:LORD, JAMES ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:LORD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 W ELK TRL
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-9373
Mailing Address - Country:US
Mailing Address - Phone:630-681-1173
Mailing Address - Fax:630-868-3948
Practice Address - Street 1:269 W ELK TRL
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-9373
Practice Address - Country:US
Practice Address - Phone:630-681-1173
Practice Address - Fax:630-868-3948
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2115213E00000X
IL016004900213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL316001998OtherCONTOLLED SUBSTANCE #
IL016004900Medicaid
ILY71049OtherBLUE CROSS
ILY71049OtherBLUE CROSS
IL480028388Medicare PIN
ILBL6305002OtherDEA NUMBER
IL537450Medicare ID - Type Unspecified
ILU74113Medicare UPIN
ILIL4170001Medicare PIN