Provider Demographics
NPI:1831129170
Name:MARCZAK, LAWRENCE (DPM)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:MARCZAK
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 1:30 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 1229
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3402
Mailing Address - Country:US
Mailing Address - Phone:312-332-0041
Mailing Address - Fax:312-332-2324
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1229
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:312-332-0041
Practice Address - Fax:312-332-2324
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003003213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016003003Medicaid
616890Medicare PIN
4959180001Medicare NSC
IL616892Medicare PIN
IL016003003Medicaid