Provider Demographics
NPI:1780851428
Name:LAURENCE, EILEEN PATRICE (MD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:PATRICE
Last Name:LAURENCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:PATRICE
Other - Last Name:EPSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:26633 NORTH MIDDLETON PARKWAY
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-9124
Mailing Address - Country:US
Mailing Address - Phone:847-256-4123
Mailing Address - Fax:224-778-5134
Practice Address - Street 1:28 CHICK ST
Practice Address - Street 2:
Practice Address - City:METROPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62960-2467
Practice Address - Country:US
Practice Address - Phone:618-524-2176
Practice Address - Fax:618-524-4131
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036054682207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services