Provider Demographics
NPI:1831147164
Name:KAUFMAN, LAWRENCE M (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:M
Last Name:KAUFMAN
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 1:2456 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2012
Mailing Address - Country:US
Mailing Address - Phone:773-235-2020
Mailing Address - Fax:773-235-2037
Practice Address - Street 1:2456 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2012
Practice Address - Country:US
Practice Address - Phone:773-235-2020
Practice Address - Fax:773-235-2037
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-074319207W00000X
IL036074319207WX0110X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus SpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036074319Medicaid
31603018OtherBLUE CROSS ID
31603018OtherBLUE CROSS ID
901650Medicare ID - Type Unspecified
D13540Medicare UPIN