Provider Demographics
NPI:1861485153
Name:SPEARS, REGINALD LAFATE (MD)
Entity Type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:LAFATE
Last Name:SPEARS
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 1:4160 ROUTE 83
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047
Mailing Address - Country:US
Mailing Address - Phone:847-415-2127
Mailing Address - Fax:
Practice Address - Street 1:4160 ROUTE 83
Practice Address - Street 2:SUITE 207
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047
Practice Address - Country:US
Practice Address - Phone:847-415-2127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2009-12-09
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
IL036-091992207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG60363Medicare UPIN